Appeals Representative Associate

Appeals Representative Associate

This position is national remote. You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. UMR, UnitedHealthcare's third-party administrator (TPA) solution, is the nation's largest TPA. When you work with UMR, what you do matters. It's that simple and it's that rewarding. In providing consumer-oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth. Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast-paced and highly diversified career.

The Appeals Representative Associate is responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. This is a full-time position (40 hours / week), Monday through Friday. Employees are required to work our normal business hours of 8 : 00 AM - 5 : 00 PM in your time zone. It may be necessary, given the business need, to work occasional overtime. We offer on the job training. Monday thru Friday 7 : 00am-3 : 00pm CST for the first 4-6 weeks, depending on how quickly candidate picks up claims processing. Then will be assigned mentor who they will shadow after training and who will serve as a resource moving forward.

Primary Responsibilities :

• Research and resolve written complaints and complex or multi-issue provider complaints submitted by consumers and physicians / providers.
• Communicate with appropriate parties regarding appeals and grievance issues, implications and decisions.
• Analyze and identify trends for appeals and grievances.
• Apply knowledge / skills to basic, repeated activities.
• Respond to standard requests and solve routine problems by following established procedures.
• Work with others as part of a team and have work reviewed by others.

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 :

Preferred Qualifications :

Telecommuting Requirements :

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.00 - $27.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline : This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.