Senior Clinical Appeals Reviewer - Multiple Locations - Full-time / Part-time

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
  
• Provide support for the supervisor
• Applies knowledge/skills to complex or escalated activities.
• Solves complex problems on own; proactively identifies new solutions to problems
• Complex tasks are completed without review by others.
• Plans, prioritize, organize and complete work to meet established objectives.
• Analyze current customer service processes and identify gaps or defects to improve overall effectiveness
• Works with the Appeals, Denials, and Infrastructure teams to define/recommend process improvements to meet current and future customer service needs/standards
• Ensure that customer needs are being met by current processes 
• Ensure appropriate usage of available resources by agents to respond to callers (e.g., applicable scripts, Subject Matter Experts)
• Perform quality audits on recorded calls and analyze results to determine process improvement opportunities
• Review/monitor results of appeals work and escalate as necessary (e.g., rebuttals)
• Demonstrate understanding of applicable Customer Care Appeal Coordinators Quality requirements/ guidelines (e.g., escalation procedures, use of SMEs)
• Adhere to established quality processes, procedures, requirements and guidelines

Diversity creates a healthier atmosphere: 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.