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Senior Clinical Appeals Reviewer - Moline, IL & Eden Prairie, MN
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Moline, IL Moline, Illinois |
About this job
Position Description:
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)
In this position you will be working within Outlook and get cases sent to you from the benefits operations unit. You will open up the cases and note all relevant information. You will put this information into a clinical response form and will populate some specific department info like state requirements, etc. You will give the cases a quick scan to see if they are appropriate to review clinically. Once that is completed you will send that information to a pharmacist for review. The pharmacist will complete this and send it back to you. You will open the case form again and look at the pharmacist determination. You will decide if the case needs to go to a Medical Director for review or go back to benefit operations for completion. This process is repetitive and ongoing. You will do it 15 to 20 times a day. Other duties as assigned.
You must have excellent verbal and written communication skills. You must have excellent organizational skills and be able to work in a fast paced environment.
Requirements
Required Qualifications:
- High School Diploma/GED.
- Experience with Microsoft Windows, Word, Excel, and Outlook.
- 6+ months of experience working in a fast paces professional environment.
Preferred Qualifications:
- Associates Degree.
- Healthcare experience.
- Managed Care experience.
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 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: 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.