Appeals Representative, UnitedHealth Group - Two Chicks With A Side Hustle

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)

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
Proficiency with Microsoft Office – Microsoft Word (documentation purposes), Microsoft Excel (data entry for reporting purposes) and Microsoft PowerPoint (create, edit, and format presentations)

Ability to work Monday – Friday 08:00AM-04:30PM CST

Preferred Qualifications:

Experienced with behavioral health care, medical, or pharmacy terminology

Experienced in appeals and/or customer dispute resolution

Telecommuting Requirements:

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 service

Soft Skills: