Clinical Appeals Reviewer

This position is national remote, offering the flexibility to telecommute from anywhere within the U.S. as you tackle meaningful challenges. At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. Your work will impact millions of lives for the better.

About the Role

This is a full-time position requiring 40 hours per week. Employees must have flexibility to work any 8-hour shift within normal business hours (8:00 am - 5:00 pm in your time zone), including 2 Saturdays per month (alternating every other Saturday) and occasional Sundays. Occasional overtime may be required based on business needs.

On-the-job paid training is provided virtually from your home, with training hours mirroring business hours (8:00 am - 5:00 pm, Monday - Saturday). Attendance is 100% required during training.

Responsibilities

• Provide expertise or general support in reviewing, researching, investigating, and resolving appeals.
• Understand appeals process rules and regulations, including turnaround time and compliance expectations.
• Demonstrate deep knowledge and skills within your function.
• Proactively identify solutions to non-standard requests.
• Solve moderately complex problems independently and collaborate with the team to address complex issues.
• Maintain accuracy and thoroughness in all data entry applications.

Requirements

• High School Diploma / GED or equivalent work experience.
• Must be 18 years of age or older.
• 1+ years of experience in a healthcare setting with exposure to health insurance processes, claims knowledge, or medical terminology.
• 1+ years of experience managing high-volume outbound calls in a fast-paced environment, delivering exceptional customer service while resolving issues and meeting performance targets.
• Proven ability to consistently meet role expectations, maintain accountability, and contribute to team and organizational goals.
• Data entry experience with large volumes of data into software systems.
• Proficiency with Microsoft Office, including Microsoft Outlook (create, edit, save, and send documents) and Microsoft Excel (create, edit, save, and send documents).
• Ability to work 5 days a week (Monday - Saturday) within business hours (8:00 am - 5:00 pm in your time zone), including 2 Saturdays per month and occasional Sundays or overtime as needed.

Preferred Qualifications

• 1+ years of health insurance appeals experience in a payor environment.
• ICD-10, CPT, and HCPCS coding experience.
• Knowledge of medical terminology.

Telecommuting Requirements

• Ability to keep all company-sensitive documents secure.
• Dedicated work area established, separated from other living areas, ensuring information privacy.
• Must live in a location that can receive a UnitedHealth Group-approved high-speed internet connection or leverage an existing high-speed service.

Skills

• Strong analytical and research skills supporting informed, equitable decision-making.
• Clear and respectful verbal and written communication fostering understanding across diverse audiences.
• Consistent delivery of high-quality results while promoting collaboration and continuous improvement.
• Active listening and information gathering to address immediate needs and anticipate future opportunities.
• Collaborative approach, valuing diverse perspectives and working effectively with colleagues, cross-functional teams, managers, and customers.
• Adaptable communication style to engage with varied cultural, linguistic, and personal preferences.
• Problem-solving expertise, assessing situations quickly and offering actionable, inclusive recommendations.
• Conflict resolution skills, maintaining professionalism under pressure, and demonstrating resilience and empathy.
• Commitment to scheduled operational hours with flexibility for training, structured breaks, and occasional schedule adjustments or overtime.

Pay

The hourly pay for this role ranges from $18.00 - $32.00 per hour based on full-time employment, determined by factors including local labor markets, education, work experience, and certifications.

Benefits

• Comprehensive benefits package (eligibility requirements apply).
• Incentive and recognition programs.
• Equity stock purchase and 401k contribution.