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Job Information

UnitedHealth Group Telephonic Clinical Appeals Coordinator - Work from Home in Maryland Heights, Missouri

If you are located in the Saint Louis, MO area, you will have the flexibility to telecommute (work from home) as you take on some tough challenges. However you must be within driving distance of Maryland Heights Office - 13655 Riverport Drive, Maryland Heights, Missouri 63033.

Energize your career with one of Healthcare’s fastest growing companies.

You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 10 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

Positions in this function are responsible for providing expertise or general support in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances regarding behavioral health. Communicates with appropriate parties’ issues, implications and decisions.

The training will be 4 weeks of general appeals training, and then phone training for one week for a total of 5 weeks. All training will be handled in the department. Training will be conducted virtually from your home.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to work our normal business hours of 7:00am – 6:00pm CST. It may be necessary, given the business need, to work occasional overtime or weekends.

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

Primary Responsibilities:

  • Provide Phone Support to drive resolution of caller Questions / Issues

  • Develop and Maintain Productive Relationships / Interactions with Callers

  • Familiar with Business / Industry concepts and terminology as pertains to appeals and grievances

  • Provide Consulting / Education on Caller Issues / Trends as pertains to Appeals and grievances

  • Resolve member service inquiries related to member and provider appeals and grievances

  • Process telephone inquiries regarding: Basic appeal rights, Appeals status, General process, Basic complaints, Urgent appeals

  • Triage calls to determine call type and transfer to the appropriate department as necessary

  • Refax letters to providers and facilities, as necessary

  • Ensure accurate documentation of calls

  • Identify requests for escalation / complaints and escalate accordingly

  • Route identified issues to the appropriate site, as necessary

  • Manage calls efficiently and effectively

  • Own problem through to resolution on behalf of the member / provider / facility in real time or through comprehensive and timely follow - up with the member /provider / facility

  • Research complex issues across multiple databases and work with support resources to resolve inquiry

  • Participate in special projects, work groups or committees as assigned

  • Other duties as assigned

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)

  • 2+ years of Call Center Experience or Customer Service Experience

  • 2+ years of Healthcare Insurance Experience (Prior Authorizations, Claims, Benefits)

  • Experience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables) and Microsoft Outlook (email and calendar management)

  • Ability to navigate a PC to open applications, send emails and conduct data entry

  • Ability to work any 8-hour shift between the hours of 7:00am - 6:00pm CST, Monday through Friday

Telecommuting Requirements:

  • Must reside within commutable distance of Maryland Heights Office - 13655 Riverport Drive, Maryland Heights, Missouri 63033

  • 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 internet service

Preferred Qualifications:

  • Familiarity with Medical Terminology

  • Experience with Claims (Claims process, EOB- Explanation of Benefits, Approvals)

  • Previous Behavioral Health Claims or Appeals Experience

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work. SM

Diversity 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.

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