Appeals Representative Associate

UnitedHealth Group•Tampa, FL

14h•$16 - $29•Remote

About The Position

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. UMR, UnitedHealthcare’s third-party administrator (TPA) solution, is the nation’s largest TPA. When you work with UMR, what you do matters. It's that simple . . . and it's that rewarding. In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth. Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast-paced and highly diversified career. Flexible, Friendly, fast on your feet, that's a great start. Accurate, Accountable, Self-Directed; These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment. The Appeals Representative Associate is responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm in your time zone. It may be necessary, given the business need, to work occasional overtime. We offer 4-6 weeks of paid on-the-job training depending on how quickly candidate picks up claims processing and the hours during training will be 7:00 am - 3:00 pm CST, Monday - Friday. Then mentors will be assigned who they will shadow after training and who will serve as a resource moving forward. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Requirements

High School Diploma / GED OR years of equivalent work experience
Must be 18 years of age OR older.
1+ years of experience analyzing and solving customer problems OR 1+ years of work experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as primary job tools
Experience with Microsoft Word (create, edit, format documents) and Microsoft Excel (create, edit, format spreadsheets)
Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm in your time zone. It may be necessary, given the business need, to work occasional overtime.

Nice To Haves

2+ years of medical claims experience
Experience with Healthcare/Medicare Terminology
Managed Care and Appeals/Grievances experience

Responsibilities

Research and resolve written complaints and complex or multi-issue provider complaints submitted by consumers and physicians/providers.
Communicate with appropriate parties regarding appeals and grievance issues, implications and decisions.
Analyze and identify trends for appeals and grievances.
Apply knowledge/skills to basic, repeated activities.
Respond to standard requests and solve routine problems by following established procedures.
Work with others as part of a team and have work reviewed by others.