Clinical Appeals Reviewer, Maryland Heights, MO

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 categories
Document request as A&G Correspondence or A&G Appeal 
Operate with high attention to detail when performing various data entry tasks
Prioritize work based on due date and run applicable work list reports to monitor workload
Plan, prioritize, organize and complete work to meet assigned deadlines
Determine if appeal is clinical or administrative and ensure correct letter template is utilized
Select, update and send department specific attachments and/or enclosure(s) 
Send out written notification as indicated under appeals policies compile IRO packets
Solve moderately complex problems individually or in a team setting
Work on high level tasks under management supervision/guidance 
Adhere to state and federal guidelines with processing appeals
Handle 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.