Senior Appeals Representative

UnitedHealthcare

Tampa (FL)

Remote

USD 27,552 - 49,207

Full time

14 days+

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Benefits offered by this job

Competitive pay

Comprehensive benefits package

401k contributions

Job summary

A national healthcare company is seeking a Senior Appeals Representative to manage and resolve appeals and grievances. This remote role requires strong analytical skills and the ability to communicate effectively with members and providers. Candidates must have a High School Diploma and at least 2 years of experience in a healthcare setting or related office environment. This position offers competitive pay and a comprehensive benefits package.

Qualifications

2+ years of experience analyzing and solving appeals and grievances in an office environment.
Knowledge of medical claims and/or billing is preferred.
Ability to work full-time with flexibility in shifts.

Responsibilities

Research and resolve written complaints submitted by consumers and physicians/providers.
Render decisions for non-clinical complaints.
Communicate appeal or grievance information to members and providers.

Skills

Analytical skills

Written communication

Multi-tasking

Microsoft Word

Microsoft Excel

Education

High School Diploma / GED

Tools

Windows PC applications

Job description

Overview

Senior Appeals Representative role at UnitedHealthcare. This position is National Remote. You’ll have the flexibility to telecommute from anywhere within the U.S. while handling challenging tasks.

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do impacts the lives of millions. Join us to help build a more responsive, affordable, and equitable health care system.

This is a full-time role (40 hours/week) with an 8-hour shift schedule during normal business hours of 7:00am – 7:00pm EST. The department is open 365 days a year and occasional overtime may be necessary.

We offer six weeks of paid training. Training hours are 8:00am to 4:30pm EST, Monday – Friday. Training will be conducted virtually from your home.

Primary Responsibilities

Research and resolve written complaints submitted by consumers and physicians/providers
Ensure complaints are categorized correctly
Obtain additional documentation required for case review
Review cases to determine if clinician review is required
Render decisions for non-clinical complaints using sound, fact-based judgment
Complete necessary documentation of final appeals or grievance determinations using appropriate templates
Communicate appeal or grievance information to members, providers, and internal/external parties within required timeframes

This role requires strong analytical skills and the ability to collaborate with other departments to obtain original claims processing details. You’ll serve as a subject matter expert on applicable regulatory guidelines and privacy policies.

Required Qualifications

High School Diploma / GED or equivalent work experience
Must be 18 years of age or older
2+ years of experience analyzing and solving appeals and grievances in an office environment using telephone and computer, or 2+ years in a healthcare setting with knowledge of medical claims and/or billing
Experience with Microsoft Word and Excel
Proficiency with computer and Windows PC applications
Ability to work full-time (40 hours/week) Monday – Saturday with flexibility to cover required shifts 7:00am – 7:00pm EST; department open 365 days a year; occasional overtime may be necessary

Telecommuting Requirements

Maintain security of all company sensitive documents (where applicable)
Must have a dedicated work area that is private and separate from living/workspace
Must live in a location with access to UnitedHealth Group approved high-speed internet

Soft Skills

Strong written communication skills with advanced grammar and spelling
Ability to multi-task and understand multiple products and levels of benefits
Adherence to UnitedHealth Group’s Telecommuter Policy

Pay and Benefits

Pay is based on factors including location, education, experience, and certifications. The hourly pay range is $20.00 - $35.72 per hour for full-time employment. We offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contributions (eligibility applies).

All benefits are subject to eligibility requirements. We comply with minimum wage laws where applicable.

Application Deadline: This job posting will be posted for a minimum of 2 business days or until a sufficient candidate pool is collected. It may be pulled early due to volume of applicants.

UnitedHealth Group is an Equal Employment Opportunity employer. We are committed to mitigating our impact on the environment and delivering equitable care. We operate a drug-free workplace; candidates must pass a drug test before employment begin.

Job Details