Appeals Representative

This position is national remote, offering the flexibility to telecommute from anywhere within the U.S.

About the role

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality, and revenue growth.

Schedule

This is a full-time position, Monday through Friday. Employees must have flexibility to work any 8-hour shift during normal business hours of 7:00 am – 5:00 pm MST. Occasional overtime may be required. We offer 4 weeks of on-the-job training, with training hours aligned to your schedule.

Responsibilities

• Research and resolve written complaints submitted by consumers and physicians/providers
• Ensure complaints are categorized correctly
• Obtain additional documentation required for case review
• Review cases to determine if clinician review is required
• Render decisions for non-clinical complaints using sound, fact-based decision making
• Complete necessary documentation of final appeals or grievance determinations using appropriate templates
• Communicate appeal or grievance information to members, providers, and internal/external parties within required timeframes

Requirements

• High School Diploma / GED or equivalent years of work experience
• Must be 18 years of age or older
• 1+ years of experience analyzing and solving customer problems
• 1+ years of experience working in a remote environment
• Proficiency with computer and Windows PC applications, including the ability to navigate and learn new and complex computer systems
• Experience with Microsoft Word (creating correspondence and working within templates) and Microsoft Outlook (email and calendar management)
• Ability to work between 7:00 am – 5:00 pm MST, Monday through Friday

Preferred Qualifications

• Experience with health care, medical, or pharmacy terminology
• Experience working with Microsoft Excel (data entry, sort/filter, and working within tables)

Telecommuting Requirements

• Ability to keep all company-sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group-approved high-speed internet connection or leverage an existing high-speed internet service

Skills

• Strong written communication skills with advanced proficiency in grammar and spelling

Pay

The hourly pay for this role ranges from $18 – $32 per hour based on full-time employment. Pay is determined by several factors, including local labor markets, education, work experience, and certifications.

Benefits

In addition to salary, we offer:

• A comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase opportunities
• 401k contributions

All benefits are subject to eligibility requirements.