Clinical Appeals Reviewer - Schaumburg, IL

Position Description:

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.

Primary Responsibilities:
Triage requests into correct categoriesDocument request as A&G Correspondence or A&G Appeal Operate with high attention to detail when performing various data entry tasksPrioritize work based on due date and run applicable work list reports to monitor workloadPlan, prioritize, organize and complete work to meet assigned deadlinesDetermine if appeal is clinical or administrative and ensure correct letter template is utilizedSelect, update and send department specific attachments and/or enclosure(s) Send out written notification as indicated under appeals policies compile IRO packetsSolve moderately complex problems individually or in a team settingWork on high level tasks under management supervision/guidance Adhere to state and federal guidelines with processing appealsHandle high claims and appeal volume while using
internal Claim, UM/UR Behavioral Health, Medical claims/appeal
management processes

Required Qualifications:


High School Diploma or GED
6+ months of Claim UR, UM experience
1+ year of experience with Windows applications, such as Microsoft Excel, Word, and Outlook
Strong data entry skills
Preferred Qualifications:

Experience with ISET, IQ and/or UMR
Familiarity with Medical Terminology
Medical Claims experience
Soft Skills:

Effective interpersonal skills with high ability to multi-task
Flexible with the ability to adapt to change
Ability to work independently as well as with a team
Ability to handle a fast pace environment, deadlines, and competing priorities
Careers with Optum.
Here's the idea. We built an entire organization around one giant
objective; make the health system work better for everyone. So when it
comes to how we use the world's large accumulation of health-related
information, or guide health and lifestyle choices or manage pharmacy
benefits for millions, our first goal is to leap beyond the status quo
and uncover new ways to serve. Optum, part of the UnitedHealth Group
family of businesses, brings together some of the greatest minds and
most advanced ideas on where health care has to go in order to reach its
fullest potential. For you, that means working on high performance
teams against sophisticated challenges that matter. Optum, incredible
ideas in one incredible company and a singular opportunity to do your life's best work.
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.