Senior Appeals Representative

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

About the role

As a Senior Appeals Representative, you will handle end-to-end processes independently with support from leaders and members. This role requires a deadline-driven and detail-oriented approach while maintaining accountability for all actions. You will manage a higher volume of appeals, which typically require less effort and time per case.

You’ll directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need. This role operates within a culture guided by inclusion, offering comprehensive benefits and career development opportunities.

Responsibilities

• Research and resolve written appeals submitted by consumers, physicians, or providers.
• Ensure appeals are categorized correctly.
• Obtain additional documentation required for case review.
• Review cases to determine if a clinician’s input is needed.
• Render decisions for non-clinical appeals 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.
• Manage assigned inventory to ensure timely and accurate resolution of cases.
• Act as a subject matter expert on applicable regulatory guidelines and privacy policies.
• Draft correspondence explaining claim resolutions, outcomes, and next steps for members.

Requirements

• High School Diploma/GED or equivalent work experience.
• Must be 18 years of age or older.
• 2+ years of experience analyzing and solving appeals and grievances or 2+ years of experience in a healthcare setting with knowledge of claims and/or claims adjustments.
• Proficiency with computer and Windows PC applications, including the ability to navigate and learn new and complex systems.
• Ability to work full-time (40 hours/week) on any 8-hour shift schedule during business hours (7:00 AM – 6:00 PM local time), Monday through Friday, with occasional overtime or weekends as needed.
• Exceptional multitasking skills with the ability to prioritize tasks.
• Strong analytical skills and ability to interact effectively with other departments.
• Strong written communication skills, including advanced grammar and spelling.

Preferred Qualifications

• Behavioral claims or appeals experience.
• Previous experience with systems such as Linx, ISET, ICUE, ACET, CSP Facets, ATS, Doc360, or EnterpriseNow.

Telecommuting Requirements

• Ability to keep all company-sensitive documents secure.
• Dedicated work area 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.

Soft Skills

• Extensive work experience within your function.
• Ability to work independently with minimal established procedures.
• May act as a resource for others and coordinate team activities.
• Strong ability to multitask, including understanding multiple products and benefit levels.

Pay

The hourly pay for this role ranges from $20 to $36 per hour based on full-time employment, depending on factors such as local labor markets, education, work experience, and certifications.

Benefits

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

Schedule

• Full-time (40 hours/week), Monday through Friday.
• Paid on-the-job training with hours from 8:00 AM to 5:00 PM, Monday through Friday.
• Flexibility to work any 8-hour shift during business hours (7:00 AM – 6:00 PM local time), with occasional overtime or weekends as needed.