UnitedHealth Group Clinical Appeals Reviewer - Telecommute in California; Nevada; Oregon or Washington in Las Vegas, Nevada

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 .(sm)

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. (Positions responsible for claims appeals can be found in the Claims job family.)

Primary Responsibilities:

  • Pull medical cases from a queue

  • Research these medical cases and create write up summaries

  • Pass medical case write up summaries on to nurses

  • Receive decisions on whether a case is approved or denied

  • Relay information to the members and document your work

  • Other duties as assigned

Required Qualifications:

  • High School Diploma / GED

  • 1+ years of experience working with Insurance Clinical Appeals

  • Previous experience working with Microsoft Office including: Microsoft Outlook (ability to create, edit, save, and send documents), Microsoft Word (ability to create, edit, save, and send documents), and Microsoft Excel (ability to create, edit, save, and send spreadsheets)

  • Ability to navigate a PC to open applications, send emails, and conduct data entry

  • Must live in: California, Nevada, Oregon or Washington

Preferred Qualifications:

  • Insurance Claims experience

  • Experience with E&I platform

  • Previous SCIIDRS, IDRS, ECAA, ETS, IQ, systems experience

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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 .SM

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.

Keywords: UHG, Healthcare, UnitedHealth, Appeals, Insurance, California, Oregon, Washington, Nevada