Appeals Representative

Optum India; Gurugram District; On-site; INR 300,000 - 600,000; Full time

Job summary

Optum India is seeking a detail‑oriented medical claims associate to ensure accurate processing and timely adjudication of claims. You will apply plan concepts such as deductible, coinsurance, copay, and out‑of‑pocket considerations while complying with company policies. Night shifts may be required as part of shifting coverage.

Ideal candidates have graduation, strong MS Office skills, excellent written and verbal communication, and a proven ability to multi‑task in a fast‑paced environment.

Qualifications

• Graduation required; BTECH/BE/MBA/B pharm/M pharm not eligible.
• Strong MS Office skills.
• Excellent verbal and written communication.
• Proven result-oriented mindset.
• Ability to accept constructive criticism and grow.
• Proven critical thinking abilities.
• Ability to multi-task across multiple products and benefits.
• Willing to work night shifts.

Responsibilities

• Accurate processing and completion of medical claims.
• Process claims that route out of automatic adjudication within current turnaround standards.
• Demonstrate proficiency in product lines applicable to processing unit.
• Understand and apply plan concepts: Deductible, Coinsurance, Copay, Out-of-pocket, State variations.
• Comply with all applicable Company policies, procedures, and business directives.

Skills

Verbal communication

Written communication

Analytical ability

Multi-tasking

Coaching receptiveness

Education

Graduation

Tools

MS Office

Job description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Primary Responsibilities

• Accurate processing and completion of medical claims
• Process claims that route out of automatic adjudication, within current turnaround standards
• Demonstrate proficiency in product lines applicable to processing unit
• Understand and apply plan concepts: Deductible, Coinsurance, Copay, Out-of-pocket, State variations
• Comply with all applicable Company policies, procedures, and business directives, changes including those relating to work location, team assignments, work schedules, and flexible work arrangements

Required Qualifications

• Graduation (BTECH / BE / MBA / B pharm / M pharm are not eligible to apply)
• Working knowledge of MS Office
• Demonstrated solid verbal and written communication skills
• Proven to be result-oriented and goal-driven
• Proven excellent communication skills written and verbal
• Proven analytical ability: Research skills combined with effective decision-making and superior interpersonal skills
• Proven ability to accept constructive criticism with being coached and growing as a professional
• Proven critical thinking abilities
• Proven ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
• Proven ability to remain focused and productive each day though tasks may be repetitive
• Good typing speed (English) and accuracy
• Willing to work night shifts

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.