Appeals Specialist

This position is Remote in CST, EST, or MST. You will have the flexibility to work remotely* 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 to start Caring. Connecting. Growing together.

As an Appeals Specialist you would be on the phone outbound and inbound calls handling any calls needed to investigate appeals working with clients, providers, and customers directly via email or phones. Entering information on to spready sheets, handling appeals and negotiating with providers, you will be multitasking in this role to handle certain appeals. In this role you will be working as part of a team, you will have weekly calls. You will also have a team lead and a manager to help assist with any questions in your role. You will be utilizing Apple Maps, Microsoft Excel, Microsoft Outlook, Microsoft Teams.

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 7:00 AM – 5:00 PM CST. It may be necessary, given the business need, to work occasional overtime.

We offer 2 weeks of paid on-the-job training. The hours of training will be aligned with your schedule.

Primary Responsibilities:

• Perform various appeal management duties from when the appeal is open until it is resolved and closed
• Reviewing, researching, investigating, negotiating, and resolving appeals via live calls; Emails and spreadsheets
• Professionally resolve claim appeals in support of the pricing methodology used for each claim as determined by the client
• Complete necessary documentation throughout the appeal process using appropriate templates
• Communicate appeal or grievance information to members, providers, clients, client advocates and / or internal / external parties within the required timeframes
• Handling live calls from members, providers, clients, and client advocates efficiently and effectively using available business rules and guidelines set by our clients in determining the appropriate course of action

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 years of work experience
• Must be 18 years of age OR older
• 2+ years of experience in Call Center Customer Service
• Ability to work any of our full time (40 hours / week), 8-hour shift schedules during our normal business hours of 7:00 AM – 5:00 PM CST from Monday – Friday. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• 2+ years of experience in negotiations, appeals, OR claims processing
• Medical, claims, OR coding experience
• Experience with MAC computers and macOS applications
• Experience with Microsoft Office products including Microsoft Word (create correspondence and work within templates), Microsoft Excel (ability to sort, filter, and create simple spreadsheets), and Microsoft Outlook (email and calendar management)

Telecommuting Requirements:

• Reside within the Central, Eastern, OR Mountain Time Zone
• 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:

• Solid written and verbal communication
• Ability to use sound judgment and critical thinking skills to resolve member or provider issues
• Solid decision – making skills
• Work independently with minimal direction and supervision including self – motivation, confidence, and problem – solving skills
• Ability to manage multiple priorities in a time sensitive manner
• Ability to work individually and as a team member
• Demonstrates initiative and resourcefulness to overcome difficulties
• Must possess solid relationship skills and work well with others
• Ability to handle high pressure situations

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.74 – $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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 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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

RPO