Clinical Appeals Reviewer - Multiple Locations

Energize your career with one of Healthcare's fastest growing
companies.  

You dream of a great career with a great company - where you can
make an impact and help people.  We dream of giving you the opportunity to
do just this.  And with the incredible growth of our business, it's a
dream that definitely can come true. Already one of the world's leading
Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate
our Service Centers, improve our Service levels and help people lead healthier
lives. We live for the opportunity to make a difference and right now, we are
living it up.

This opportunity is with one of our most exciting business areas:
Optum - a growing part of our family of companies that make UnitedHealth Group
a Fortune 14 leader.

Optum helps nearly 60 million Americans live their lives to the
fullest by educating them about their symptoms, conditions, and treatments;
helping them to navigate the system, finance their Healthcare needs, and stay
on track with their Health goals. No other business touches so many lives in
such a positive way. And we do it all with every action focused on our shared
values of Integrity, Compassion, Relationships, Innovation, and Performance.

• Provide Phone Support to drive resolution of caller Questions/Issues. 
• Develop and Maintain Productive Relationships/Interactions with Callers.  
• Familiar with Business/Industry concepts and terminology as pertains to appeals and grievances
• Provide Consulting/Education on Caller Issues/Trends as pertains to Appeals and grievances.
• Resolve member service inquiries related to member and provider appeals and grievances:
• Process telephone inquiries regarding: Basic appeal rights, Appeals status, General process, Basic complaints, Urgent appeals
• Triage calls to determine call type and transfer to the appropriate department as necessary
• Refax letters to providers and facilities, as necessary
• Ensure accurate documentation of calls
• Identify requests for escalation/complaints and escalate accordingly
• Route identified issues to the appropriate site, as necessary
• Manage calls efficiently and effectively
• Own problem through to resolution on behalf of the member /provider/facility in real time or through comprehensive and timely follow-up with the member/provider/facility 
• Research complex issues across multiple databases and work with support resources to resolve inquiry 
• Participate in special projects, workgroups or committees as assigned.
• Other duties as assigned

• Some College OR a High School Diploma/GED with 3+ years of Customer Service, Appeals, or Claims experience.
• 1+ year of Telephonic Customer Service experience.
• 1+ year of Healthcare Insurance experience .
• Proficient using a computer and Microsoft Office (MS Word, MS Excel, and MS Outlook)
• Demonstrated experience utilizing communication skills both verbal and written in a professional setting.

• Familiarity with Medical Terminology.