Research and resolve written complaints submitted by consumers and physicians/providers. Ensure complaint has been categorized correctly. Obtain additional documentation required for case review. Review case to determine if review by clinician is required. Render decision for non-clinical complaints using sound, fact-based decision making. Complete necessary documentation of final appeals or grievance determination using appropriate templates. Communicate appeal or grievance information to membe... more details
If you are located within the state of California, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.
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 diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
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. Communicates with appropriate parties issues, implications and decisions. Analyzes and identifies trends for appeals and grievances. This includes senior level positions with education/certification/licensure other than an RN, such as BSW, MSW, DDS, Chiropractor, Physical Therapist, etc.
This position is full time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am 5:00pm PST. It may be necessary, given the business need, to work occasional overtime.
*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.
Primary Responsibilities:
- Research and resolve written complaints submitted by consumers and physicians/providers.
- Ensure complaint has been categorized correctly.
- Obtain additional documentation required for case review.
- Review case to determine if review by clinician is required.
- Render decision for non-clinical complaints using sound, fact-based decision making.
- Complete necessary documentation of final appeals or grievance determination using appropriate templates.
- Communicate appeal or grievance information to members or providers and internal/external parties within the required timeframes.
Youll 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
- 1+ years of experience analyzing and solving customer problems OR 1+ years of work experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
- Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
- Must be 18 years of age OR older
- Ability to work full-time, Monday - Friday between 8:00am 5:00pm PST including the flexibility to work occasional overtime given the business need
Telecommuting Requirements:
- Reside within the state of California
- 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.
California Residents Only: Thehourly range for California residents is $19.47 - $38.08 per hour.Pay is based on several factors including but not limited tolocal labor markets, education, work experience, certifications, etc.UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, youll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyoneof every race, gender, sexuality, age, location, and incomedeserves 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.
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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