Appeals Representative

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

Required Qualifications

• High School Diploma / GED OR equivalent years of work experience
• Must be 18 years of age OR older
• 1+ years of experience with analyzing and solving customer problems
• 1+ years of experience working in a remote environment
• Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
• Experience with Microsoft Word (create correspondence and work within templates)
• Experience with Microsoft Outlook (email and calendar management)
• Ability to work full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 5:00 pm MST. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications

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

Telecommuting Requirements

• 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 service

Soft Skills

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

Pay and Benefits

The hourly pay for this role will range from $18.00 - $32.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

We offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).

No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives.

We are committed to helping people live healthier lives and making 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified candidates will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.