Appeals Representative – Remote Jobs in Remote in Dallas at Optum

Title: Appeals Representative – Remote

Company: Optum

Location: Remote in Dallas

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Let’s talk about diplomacy. Let’s talk about accuracy. Let’s talk about howUnitedHealth Groupbecame a Fortune 10 company leader in health care. We did it by working to become an undisputed leader in creating quality service and helping to improve the lives of millions. Now, here’s where you come in. You can build on your problem-solving skills by taking on responsibility for reviewing, researching, investigating and triaging claims that were denied to determine their correct status. You’ll drive the action and communicate with appropriate parties regarding appeals and grievance issues. In turn, we’ll provide you with the great training, support and opportunities you’d expect from a Fortune 10 company .

This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (8:00am – 4:30pm) CST. It may be necessary, given the business need, to work occasional overtime.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

Research and resolve written appeals requests submitted by consumers and physicians/providers

Ensure appeals have been categorized correctly

Obtain additional documentation required for case review

Review case to determine if review by clinician is required

Facilitate decision for non-clinical appeals using sound, fact-based decision making

Complete necessary documentation of final appeals or grievance determination using appropriate templates

Communicate appeal or grievance information to participants 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 case processing details. You’ll also need to effectively draft correspondence that explains the case resolution/outcome as well as next steps/actions for the participant.

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

Intermediate level experience using Microsoft Excel

1+ years’ Experience with health care, medical, behavioral health, or pharmacy terminology

1+ year experience with electronic medical records systems or other medical software

2+ years’ experience working with appeals, complaints, and Grievances

Preferred Qualifications:

Experience with health care, medical, or pharmacy terminology

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 …

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