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Clinical Appeals Reviewer

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UnitedHealthcare

Dec 5

  • Job
    Full-time
    Junior Level
  • Customer Relations
    Healthcare
  • Dallas
    Remote

AI generated summary

  • You need a high school diploma, 1+ year in healthcare/customer service, data entry, knowledge of coding, and strong communication skills. Must work flexible hours and secure a private workspace.
  • You will review and resolve appeals, ensure compliance with regulations, identify solutions to issues, and maintain accuracy in data entry while collaborating to tackle complex problems.

Requirements

  • High School Diploma / GED OR equivalent work experience
  • Must be 18 years of age OR older
  • 1+ years of experience in a healthcare setting with exposure to health insurance processes, claims knowledge, and/OR medical terminology
  • 1+ years of experience managing high-volume outbound calls in a fast-paced environment, delivering exceptional customer service while quickly resolving issues and meeting performance targets
  • Experience with consistently meeting role expectations, maintaining accountability, and contributing to team and organizational goals
  • Data entry experience entering large volumes of data into software systems
  • Experience working with Microsoft Office including Microsoft Outlook (ability to create, edit, save, and send documents) and Microsoft Excel (ability to create, edit, save, and send documents)
  • Ability to work 5 days a week, Monday - Saturday. Employees are required to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm in your time zone, including the ability to work 2 Saturdays per month (Alternating every other Saturday and the possibility of working on Sundays when needed). It may be necessary, given the business need, to work occasional overtime.
  • 1+ years of health insurance appeals experience in a payor environment
  • ICD10, CPT and HCPCS coding experience
  • Medical Terminology knowledge
  • 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.
  • Strong analytical and research skills that support informed and equitable decision-making
  • Clear and respectful verbal and written communication that fosters understanding across diverse audiences
  • Consistent delivery of high-quality results while promoting collaboration and continuous improvement
  • Active listening and information gathering to address immediate needs and anticipate future opportunities
  • Collaborative approach, valuing diverse perspectives and working effectively with colleagues, cross-functional teams, managers, and customers
  • Adaptable communication style to engage with varied cultural, linguistic, and personal preferences
  • Problem-solving expertise, assessing situations quickly and offering actionable, inclusive recommendations
  • Conflict resolution skills, maintaining professionalism under pressure and demonstrating resilience and empathy
  • Commitment to scheduled operational hours with flexibility for training, structured breaks, and occasional schedule adjustments or overtime
  • All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Responsibilities

  • Provides expertise or general support in reviewing, researching, investigating, and resolving appeals
  • Understands the appeals process rules and regulations, including turnaround time and compliance expectations
  • Demonstrates great depth of knowledge/skills in own function
  • Proactively identifies solutions to non-standard requests
  • Solves moderately complex problems on own
  • Works with team to solve complex problems
  • Maintain accuracy and thoroughness in all applications for data entry

FAQs

What is the job title for this position?

The job title is Clinical Appeals Reviewer.

Is this position remote?

Yes, this position is National Remote, allowing you to telecommute from anywhere within the U.S.

What are the working hours for this job?

The position is full-time, requiring 5 days a week of availability from Monday to Saturday, during the normal business hours of 8:00am - 5:00pm in your time zone.

Are employees expected to work on weekends?

Yes, employees must have the ability to work 2 Saturdays per month, with the possibility of working on Sundays when needed.

What type of training is provided for this position?

We offer on-the-job paid training, which will be conducted virtually from your home. Attendance is 100% required for training.

What are the primary responsibilities of a Clinical Appeals Reviewer?

The primary responsibilities include reviewing, researching, investigating, and resolving appeals, understanding the appeals process and compliance expectations, and identifying solutions to non-standard requests.

What qualifications are required for this role?

Required qualifications include a High School Diploma/GED or equivalent work experience, at least 1 year of experience in a healthcare setting, customer service experience, and data entry experience.

Are there any preferred qualifications for this position?

Yes, preferred qualifications include 1+ years of health insurance appeals experience, ICD10, CPT, and HCPCS coding experience, and knowledge of medical terminology.

What are the soft skills necessary for this role?

Necessary soft skills include strong analytical and research skills, clear communication, problem-solving expertise, conflict resolution skills, and the ability to adapt communication styles.

What is the pay range for this position?

The hourly pay for this role will range from $17.74 to $31.63 per hour based on full-time employment.

Is there flexibility in the work schedule?

Yes, occasional schedule adjustments or overtime may be necessary based on business needs, and employees must commit to scheduled operational hours.

What are the telecommuting requirements for this job?

Employees must secure company documents, have a dedicated work area, and have access to a UnitedHealth Group approved high-speed internet connection.

Does UnitedHealth Group have a commitment to diversity and inclusion?

Yes, UnitedHealth Group is committed to equitable care and addressing health disparities, supporting diversity across all aspects of employment.

What benefits are offered beyond salary?

In addition to salary, benefits include a comprehensive package, incentive and recognition programs, equity stock purchase, and 401k contribution, all subject to eligibility requirements.

Will a drug test be required for this position?

Yes, candidates are required to pass a drug test before beginning employment.

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UnitedHealthcare

Science & Healthcare
Industry
10,001+
Employees

Mission & Purpose

When it comes to your health, everything matters. That’s why UnitedHealthcare is helping people live healthier lives and making the health system work better for everyone. Our health plans are there for you in moments big and small, delivering a simple experience, affordable coverage, and supportive care. Wherever your health takes you, we're there for what matters. At UnitedHealthcare, part of the UnitedHealth Group family of businesses, we are working to create a system that is connected, aligned and more affordable for all involved; one that delivers high quality care, responsive to the needs of each person and the communities in which they live. With connections to more than 1.3 million physicians and care professionals and 6,500 hospitals and care facilities across the globe, we can collaborate in new ways to improve patient care while providing customizable and comprehensive solutions in any marketplace, anywhere.

Culture & Values

  • Integrity

    Honor commitments. Never compromise ethics.

  • Compassion

    Walk in the shoes of the people we serve and those with whom we work.

  • Relationships

    Build trust through collaboration.

  • Innovation

    Invent the future. Learn from the past

  • Performance

    Demonstrate excellence in everything we do.

Benefits

  • United Well-being

    United Well-being supports employees in their journey to better health. Resources include: Exercise and mindfulness apps. Tips and recipes for healthy cooking. Wellness coaching and financial tools. A private employee community group.

  • Health and Insurance

    Our medical plans for employees deliver better value and better outcomes. We offer: Copay plans and HSA-eligible plans. Vision and dental plans. Flexible spending accounts. Life insurance, and more.

  • Savings and Retirement

    In addition to competitive pay, we provide financial benefits to help employees manage their money. Benefits include: 401(k) Savings Plan. Employee Stock Purchase Plan. UnitedHealth Group credit union, and more.

  • Paid Time Off (PTO)

  • Paid Company Holidays

  • Parental Leave

  • Employee Assistance Program