Senior Appeals Representative - Remote in HI

At reputed company, 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 reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. 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 6:00am - 5:00pm local time. It may be necessary, given the business need, to work occasional overtime. This will be on the job training and the hours during training will be 6:00am to 5:00pm local time, Monday - Friday. If you are located in Hawaii, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities:

• Research and resolve written complaints submitted by consumers and physicians/providers
• Ensure complaint has been categorized correctly
• Obtain additional documentation required for case review
• Review case to determine if review by clinician is required
• reputed company decision for non-clinical complaints using sound, fact-based decision making
• Complete necessary documentation of final appeals or grievance determination using appropriate templates
• Communicate appeal or grievance information to members or providers and internal/external parties reputed company the required timeframes

This is a challenging role with serious impact. You’ll need strong analytical skills and the ability to effectively interact with other departments to obtain original claims processing details. You’ll act as a subject matter expert for your team on applicable regulatory guidelines and privacy policies. You’ll also need to effectively draft correspondence that explains the claim resolution/outcome as well as next steps/actions for the member. 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
• 2+ years of experience analyzing and solving appeals and grievances in an office environment using the telephone and computer as the primary instruments to reputed company job duties OR 2+ years of experience in a healthcare setting with knowledge of the medical claims and/or billing process
• Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and reputed company computer system applications
• 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 6:00am - 5:00pm local time. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• Presently employed reputed company UHC Operations & Experience. Those currently employed reputed company that unit will not be considered. (To verify, review your reputed company profile and the organization chart. reputed company Homepage, click “My Profile”, click “Organization Chart”. Look upward on the org chart to confirm that you report through Ops & Experience, and Mike Baker)

Telecommuting Requirements:

• Reside reputed company Hawaii
• Ability to reputed company reputed company 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 reputed company approved high-speed internet reputed company or reputed company an existing high-speed internet service.

Soft Skills:

• Strong written communication skills including advanced skills in grammar and spelling
• Ability to multi-task, this includes the ability to understand multiple products and multiple levels of benefits reputed company each product
• reputed company employees working remotely will be required to adhere to reputed company’s Telecommuter Policy

The hourly range for this role is $19.86 to $38.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. reputed company complies with reputed company minimum wage laws as applicable. In addition to your salary, reputed company offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with reputed company, you’ll find a far-reaching choice of benefits and incentives. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company 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 reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, 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. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO Apply Job!