MeridianRecruiter Since 2001
the smart solution for Meridian jobs

Senior Clinical Appeals Reviewer - Pacific Remote

Company: UnitedHealth Group
Location: Star
Posted on: May 3, 2021

Job Description:

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SMThe Clinical Appeals Reviewer is responsible for reviewing, researching, investigating, and triaging all types of appeals and grievances. Communicates with appropriate parties regarding appeals and grievance issues.Positions in this function are responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. Communicates with appropriate parties regarding appeals and grievance issues, implications and decisions. Analyzes and identifies trends for all appeals and grievances. May research and resolve written Department of Insurance complaints and complex or multi-issue provider complaints submitted by consumers and physicians / providers. Employees in jobs labeled with SCA must support a Government Service Contract Act (SCA) Agreement.This position is full-time (40 hours/week) Monday - Friday. Employees are required to work our normal business hours between 6:00am - 5:00pm PST.You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Training will be conducted virtually from your home.* All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.Primary Responsibilities:* Ensure complaint has been categorized correctly* Determine and confirm member eligibility and benefits* Obtain additional documentation required for case review* Place relevant documents into image repository* Initiate outbound contact to members or providers* Review case to determine if review by Clinician is required* Research and resolve written complaints submitted by consumers and physicians / providers* Render decision for non-clinical complaints using sound, fact-based decision making* Draft verbiage for use in outbound correspondence* Prioritize and organize tasks to meet compliance deadlines* Ability to meet established productivity, schedule adherence, and quality standardsYou'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 telephonic customer service experience* Ability to work our normal business hours between 6:00am - 5:00pm PST* Must have California HMO Experience* Must have California Commercial Appeals experience* If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking ordersPreferred Qualifications:* Bilingual and fluent in English and Spanish* Experience with NICE, Resolution, ECAA, Adhoc, ETS, and Client Letter* Intake experience* Experience working on Appeals* Knowledge of HMO and / or ClaimsUnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non - clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us. You can learn more about all we are doing to fight COVID-19 and support impacted communities at: Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 10 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SMDiversity 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.Keywords: UnitedHealth Care; Clinical; Appeals; California HMO; Commercial Appeals; Reviewer; Healthcare; Bilingual; work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #rpo

Keywords: UnitedHealth Group, Meridian , Senior Clinical Appeals Reviewer - Pacific Remote, Healthcare , Star, Idaho

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Log In or Create An Account

Get the latest Idaho jobs by following @recnetID on Twitter!

Meridian RSS job feeds