UnitedHealth Group Clinical Appeals Reviewer - Maryland Heights, MO in Maryland Heights, Missouri
Energize your career with one of Healthcare’s fastest growing companies.
You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our Service Centers, improve our Service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions, and treatments; helping them to navigate the system, finance their Healthcare needs, and stay on track with their Health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation, and Performance.
Positions in this function are responsible for providing direct phone-based customer interaction to answer and resolve a variety of inquiries related to appeals and/or provider disputes.
Provide client, member and / or provider support to drive resolution of issues that may arise
Develop and maintain productive and positing contacts and follow - up with clients, members and / or providers either via phone, email, mail or fax
Be familiar with business / industry concepts and terminology as pertains to appeals, grievances and claims processing
Provide consulting / education to clients based on issue/trends as it pertains the assigned appeal, grievance or claim
Resolve member service inquiries as it relates to the member and / or provider
Process telephone inquiries regarding: basic appeal rights, appeals status, general process, basic complaints, urgent appeals and claims processing, where applicable
Triage calls, email, fax or mail received to determine resolution type and transfer to the appropriate department, where applicable
Receive, process, refax or re - route letters to providers and facilities, where applicable
Ensure accurate documentation of all forms of communications received by clients, members and / or providers
Identify requests for escalation / complaints and escalate accordingly
Route identified issues to the appropriate site, as necessary
Own problem through to resolution on behalf of the member / provider / facility in real time or through comprehensive and timely follow - up with the member/provider / facility
Research complex issues across multiple databases and work with support resources to resolve inquiry independently
Participate in special projects, workgroups or committees, as assigned
Plans, prioritize, organize and complete work to meet established and required timeframes
Ensure the correct letter template is utilized when selecting the correct attachments and/or enclosure(s)
Fully complete system templates, as required and in accordance with internal processes
Send completed written notification as indicated under applicable department policies
Work with team to solve complex problems, where applicable
Work with under supervision / guidance on high level tasks with strict deadlines
Other duties as assigned
High School Diploma / GED (or higher)
1+ years of Healthcare Insurance experience
Experience using a computer and Microsoft Office (MS Word, MS Excel, and MS Outlook) Ability to create, edit, copy, send and save documents, correspondence, and spreadsheets
1+ years of Telephonic Customer Service experience
Experience with ISET, IQ and / or UMR is highly desired.
Familiarity with Medical Terminology
Medical Claims experience.
Effective interpersonal skills, flexibility and ability to handle change
Demonstrate personal resilience
Excellent verbal, written, computation and organizational skills required
Strong time management and attention to detail
Excellent conflict management skills
Ability to work independently as well as a member of the team
Must have exceptional multi - tasking skills with the ability to prioritize tasks
Ability to handle a fast pace, deadlines, and competing priorities
Experience utilizing communication skills both verbal and written in a professional setting
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum , incredible ideas in one incredible company and a singular opportunity to do your life's best work. SM
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Keywords: Optum; Optum Health; Clinical; Appeals; Telephonic Customer Service; Reviewer