Clinical Appeals Reviewer Job at UnitedHealthcare, Dallas, TX

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  • UnitedHealthcare
  • Dallas, TX

Job Description

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.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

This position is full-time, 5 days a week, Monday - Saturday. 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, including the ability to work 2 Saturdays per month (Alternating every other Saturday and the possibility of working on Sundays when needed). It may be necessary, given the business need, to work occasional overtime.

We offer on the job paid training. The hours of training will be 8:00am - 5:00pm in your time zone, Monday - Saturday, or during your normally scheduled shift. Training will be conducted virtually from your home. Attendance is 100% required for training.

Primary Responsibilities

  • Provides expertise or general support in reviewing, researching, investigating, and resolving appeals
  • Understands the appeals process rules and regulations, including turnaround time and compliance expectations
  • Demonstrates great depth of knowledge/skills in own function
  • Proactively identifies solutions to non-standard requests
  • Solves moderately complex problems on own
  • Works with team to solve complex problems
  • Maintain accuracy and thoroughness in all applications for data entry

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications

  • High School Diploma / GED OR equivalent work experience
  • Must be 18 years of age OR older
  • 1+ years of experience in a healthcare setting with exposure to health insurance processes, claims knowledge, and/OR medical terminology
  • 1+ years of experience managing high-volume outbound calls in a fast-paced environment, delivering exceptional customer service while quickly resolving issues and meeting performance targets
  • Experience with consistently meeting role expectations, maintaining accountability, and contributing to team and organizational goals
  • Data entry experience entering large volumes of data into software systems
  • Experience working with Microsoft Office including Microsoft Outlook (ability to create, edit, save, and send documents) and Microsoft Excel (ability to create, edit, save, and send documents)
  • Ability to work 5 days a week, Monday - Saturday. Employees are required to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm in your time zone, including the ability to work 2 Saturdays per month (Alternating every other Saturday and the possibility of working on Sundays when needed). It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications

  • 1+ years of health insurance appeals experience in a payor environment
  • ICD10, CPT and HCPCS coding experience
  • Medical Terminology knowledge

Telecommuting Requirements

  • Ability to keep all company sensitive documents secure (if applicable)
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills

  • Strong analytical and research skills that support informed and equitable decision-making
  • Clear and respectful verbal and written communication that fosters understanding across diverse audiences
  • Consistent delivery of high-quality results while promoting collaboration and continuous improvement
  • Active listening and information gathering to address immediate needs and anticipate future opportunities
  • Collaborative approach, valuing diverse perspectives and working effectively with colleagues, cross-functional teams, managers, and customers
  • Adaptable communication style to engage with varied cultural, linguistic, and personal preferences
  • Problem-solving expertise, assessing situations quickly and offering actionable, inclusive recommendations
  • Conflict resolution skills, maintaining professionalism under pressure and demonstrating resilience and empathy
  • Commitment to scheduled operational hours with flexibility for training, structured breaks, and occasional schedule adjustments or overtime
  • All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.74 - $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Job Tags

Hourly pay, Minimum wage, Full time, Work experience placement, Live in, Work at office, Local area, Immediate start, Remote work, Shift work,

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