Position Description:For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work. 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. Primary Responsibilities:Pull medical cases from a queueResearch these medical cases and create write up summariesPass medical case write up summaries on to nursesReceive decisions on whether a case is approved or deniedRelay information to the members and document your workOther duties as assigned
Required Qualifications:High School Diploma / GED or higherMust live in west coast : California, Oregon, WashingtonMust be able to use various software Ability to create, copy, edit, send & save utilizing Word, Excel & Outlook1+ years of experience working with Insurance Clinical AppealsPreferred Qualifications: Insurance Claims experienceExperience with E&I platformPrevious SCIIDRS, IDRS, ECAA,ETS, IQ, systems experience Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 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: Appeals, review, grant, approve, decline
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.