Appeals Representative Senior – National Remote – UnitedHealth Group – Wausau, WI

Job title: Appeals Representative Senior – National Remote

Company: UnitedHealth Group

Job description: You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life’s best work.SMUMR, UnitedHealthcare’s third-party administrator (TPA) solution, is the nation’s largest TPA. When you work with UMR, what you do matters. It’s that simple . . . and it’s that rewarding.In providing consumer – oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast – paced and highly diversified career.This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work an 8-hour shift schedules during our normal business hours of 5:00am – 9:00pm CST. You’ll be able to set your own schedule within this time frame, as long as you work that schedule consistently. It may be necessary, given the business need, to work occasional overtime.We offer 10 weeks of on the job training. The hours during training will be 7:30 am to 4 pm CST, Monday – Friday. 100% attendance required. More details on the training will be discussed further during the interview process by the hiring manager. Training will be conducted virtually from your home.*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.Primary Responsibilities:

• Review, research, investigate and audit claims and provide feedback to team members on audit results
• Analyze and identify trends and provide feedback and reports to reduce errors and improve claims processes and performance
• Analyze information and utilize to build recommendations to reduce errors and improve process performance
• Create, maintain and track reports in relation to performance

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 equivalent experience
• Must be 18 years of age or older
• 1+ years of current or previous claims processing or appeals experience within healthcare industry
• Intermediate level of Microsoft Excel (data entry, sorting/filtering, pivot tables)
• Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications

• Previous experience supporting GEHA members
• Ability to work full-time Monday – Friday. Employees are required to have flexibility to work an 8-hour shift schedules during our normal business hours of 5:00am – 9:00pm CST. You’ll be able to set your own schedule within this time frame, as long as you work that schedule consistently. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 1+ years of experience analyzing and solving appeals and grievances in an office environment using the telephone and computer as the primary instruments to perform job duties
• 1+ years of claims processing experience with UMR CPS (claims processing system). (UMR is UnitedHealthcare’s third-party administrator (TPA) solution). (You must be an employee of UMR specifically to have experience with the UMR claims system).
• Intermediate level of Microsoft PowerPoint (create and edit presentations)
• Reside within Kansas City, MO or live within a reasonable commuting distance

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• 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:

• Ability to multi-task, this includes the ability to understand multiple products and multiple levels of benefits within each product

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for California / Colorado / Connecticut / Hawaii / Nevada / New York / New Jersey / Washington / Rhode Island residents is $19.47 – $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for At UnitedHealth Group, our mission is to help people live healthier lives and make 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. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.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.#RPO

Expected salary: $19.47 – 38.08 per hour

Location: Wausau, WI

Job date: Sat, 04 May 2024 22:11:34 GMT

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