Appeals Representative - Remote in Hawaii

Company: UnitedHealth Group
Location: Wahiawa
Posted on: May 24, 2023

Job Description:

If you are located within the state of Hawaii, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges. At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.SMLet's talk about diplomacy.-- Let's talk about accuracy. Let's talk about how UnitedHealth Group became a Fortune 5 company leader in health care. We did it by working to become an undisputed leader in creating quality service and helping to improve the lives of millions. Now, here's where you come in. You can build on your problem-solving skills by taking on responsibility for reviewing, researching, investigating and triaging claims that were denied to determine their correct status. You'll drive the action and communicate with appropriate parties regarding appeals and grievance issues. In turn, we'll provide you with the great training, support and opportunities you'd expect from a Fortune 5 company.This position is full-time (40 hours/week) Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime and/or weekends.*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.Primary Responsibilities:

• Research and resolve written complaints submitted by consumers and physicians/providers
• Ensure complaint has been categorized correctly
• Obtain additional documentation required for case review
• Review case to determine if review by clinician is required
• Render decision for non-clinical complaints using sound, fact-based decision making
• Complete necessary documentation of final appeals or grievance determination using appropriate templates
• Communicate appeal or grievance information to members or providers and internal/external parties within the required timeframes This is a challenging role with serious impact. You'll need strong analytical skills and the ability to effectively interact with other departments to obtain original claims processing details.-- You'll also need to effectively draft correspondence that explains the claim resolution/outcome as well as next steps/actions for the member. --You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:
  • High School Diploma / GED (or higher) OR equivalent years of work experience
  • 1+ years of experience analyzing and solving customer problems OR 1+ years of work experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
  • Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
  • Ability to work our normal business hours of--8:00am to 5:00pm,--Monday - FridayPreferred Qualifications:
    • Experience with health care, medical, or pharmacy terminologyTelecommuting Requirements:
    • Reside within the state of Hawaii
    • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
    • Ability to keep all company sensitive documents secure (if applicable)Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet serviceSoft Skills:
      • Strong written communication skills including advanced skills in grammar and spelling----Taking care of business at UnitedHealth Group translates to more meaning and impact as you help improve the lives of millions. Join us.-- Learn more about how you can start doing your life's best work.SMCareers with UnitedHealthcare. Work with a Fortune 5 organization that's serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.--Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.#RPO #YELLOW

Keywords: UnitedHealth Group, Honolulu , Appeals Representative - Remote in Hawaii, Other , Wahiawa, Hawaii