Senior Appeals Representative - Remote in AZ

reputed company is a health care and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of two distinct and complementary businesses, reputed company and reputed company, working to build a reputed company system for reputed company. Here, your contributions matter as they will help transform health care for years to come. reputed company an impact with a diverse team that shares your passion for helping others. Join us to start Caring. Connecting. Growing together. Let’s talk about diplomacy. Let’s talk about accuracy. Let’s talk about how reputed company became a Fortune 10 company leader in healthcare. We did it by working to become an undisputed leader in creating service quality and helping to improve the lives of millions. Now, here’s where you come in. You can build on your problem-solving skills by taking on responsibility for reviewing, researching, investigating and triaging claims that were denied determining their correct status. You’ll drive the action and communicate with appropriate parties regarding appeals and grievance issues. In turn, we’ll provide you with great training, support and opportunities. 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). It may be necessary, given the business need, to work occasional overtime. Our office is located at Arizona. This will be on the job training and the hours during training will be 6am to 5pm, Monday – Friday. If you are located in Arizona, 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

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 higher) 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). 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 Arizona
• 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. Diversity creates a healthier atmosphere: reputed company is an Equal Employment Opportunity / Affirmative Action employer, and reputed company qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national reputed company, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #RED Apply Job!