At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
Positions in this function are responsible for setting up the Appeals and Grievance cases for the Coordinators, Nurses and Doctors to review for a determination of denial. Position consists of reading and analyzing the member's correspondence and determining what the complaint is which could lead to several different issues. The Clinical Appeals Representative needs to be able to distinguish between Quality of Care, Appeal, Grievances, Expedited, Claims, Referral issues and determining exactly what the member is wanting in their letters. Position involves, calling to obtain the correct information from Member, Medical Groups, Providers, and other Departments. Position requires regulatory turnaround times. Accuracy is a very important part of this position.
This position is full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm PST. It may be necessary, given the business need, to work occasional overtime. Employees are required to work 3 days onsite and 2 days from home.
We offer 2-3 weeks of paid training. The hours during training will be 8:00 am to 5:00 pm PST, Monday - Friday. Training will be hybrid, some days in the office some days at home.
If you are within commutable distance to the office at 5701 Katella Ave., Cypress, CA 90630 you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.
Primary Responsibilities
Required Qualifications
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves 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.
#RPO
Positions in this function are responsible for setting up the Appeals and Grievance cases for the Coordinators, Nurses and Doctors to review for a determination of denial. Position consists of reading and analyzing the member's correspondence and determining what the complaint is which could lead to several different issues. The Clinical Appeals Representative needs to be able to distinguish between Quality of Care, Appeal, Grievances, Expedited, Claims, Referral issues and determining exactly what the member is wanting in their letters. Position involves, calling to obtain the correct information from Member, Medical Groups, Providers, and other Departments. Position requires regulatory turnaround times. Accuracy is a very important part of this position.
This position is full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm PST. It may be necessary, given the business need, to work occasional overtime. Employees are required to work 3 days onsite and 2 days from home.
We offer 2-3 weeks of paid training. The hours during training will be 8:00 am to 5:00 pm PST, Monday - Friday. Training will be hybrid, some days in the office some days at home.
If you are within commutable distance to the office at 5701 Katella Ave., Cypress, CA 90630 you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.
Primary Responsibilities
- Receive appeal or grievance documentation and determine relevant details (e.g., what member is requesting)
- Enter appeals and grievances details within the system and audit against provided documentation.
- Determine where appeal or grievance should be reviewed / handled or route to other departments as appropriate
- Contact and work with other internal resources to obtain and clarify information
- Complete appeal or grievance review procedures according to relevant regulatory or contractual requirements, processes, and timeframes
Required Qualifications
- High School Diploma / GED
- Must be 18 years of age or older
- 6+ months of Telephonic Customer Service experience
- 35+ WPM typing skills
- Ability to use Microsoft Office - Microsoft Word (create and edit correspondence), Microsoft Excel (ability to create, edit, and sort spreadsheets, basic analytical formulas (Vlookup), and Microsoft Outlook (email and calendar management)
- Availability to work overtime as needed during peak times as mandated by the department.
- Ability to work onsite at least 3 days a week at the Cypress, CA office and may telecommute when not in the office if meets Telecommuting requirements.
- Ability to work is full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm PST. It may be necessary, given the business need, to work occasional overtime.
- Medical Terminology experience
- Experience in Claims, Managed Care HMO, Doctor's office, and / or Billing
- Reside within commutable distance to the office at 5701 Katella Ave., Cypress, CA 90630
- 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.
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves 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.
#RPO