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UnitedHealth Group

Telephonic Clinical Appeals Reviewer - St. Louis, MO

UnitedHealth Group - Saint Louis, MO

Position Description Position Description:Energize your career with one of Healthcare’s fastest growing companies. You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our Service Centers, improve our Service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader. Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions, and treatments; helping them to navigate the system, finance their Healthcare needs, and stay on track with their Health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation, and Performance.Positions in this function are responsible for providing expertise or general support in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. Communicates with appropriate parties issues, implications and decisions. Analyzes and identifies trends for appeals and grievances. This includes senior level positions with education / certification / licensure other than an RN, such as BSW, MSW, DDS, Chiropractor, Physical Therapist, etc. (Positions responsible for claims appeals can be found in the Claims job family.)Must live in or near St Louis, MO, Atlanta, GA, or San Francisco, CA.Primary Responsibilities:Provide Phone Support to drive resolution of caller Questions / IssuesDevelop and Maintain Productive Relationships / Interactions with CallersFamiliar with Business / Industry concepts and terminology as pertains to appeals and grievancesProvide Consulting / Education on Caller Issues / Trends as pertains to Appeals and grievancesResolve member service inquiries related to member and provider appeals and grievancesProcess telephone inquiries regarding: Basic appeal rights, Appeals status, General process, Basic complaints, Urgent appealsTriage calls to determine call type and transfer to the appropriate department as necessaryRefax letters to providers and facilities, as necessaryEnsure accurate documentation of callsIdentify requests for escalation / complaints and escalate accordinglyRoute identified issues to the appropriate site, as necessaryManage calls efficiently and effectivelyOwn problem through to resolution on behalf of the member / provider / facility in real time or through comprehensive and timely follow-up with the member / provider / facilityResearch complex issues across multiple databases and work with support resources to resolve inquiryParticipate in special projects, work groups or committees as assignedOther duties as assigned Required Qualifications:High School Diploma / GED (or higher)1 years of Telephonic Customer Service experience in a call center environment1 years of Healthcare Insurance experienceExperience with Word, Excel & Outlook. (Word - Create correspondence and work within templates. Excel - Data Entry, Sort / Filter, and work within tables. Outlook - email and calendar management.)Ability to navigate a PC to open applications, send emails and conduct data entry.Comfortable working Monday through Friday between hours of 7:00 am - 7:00 pm CST in other locations with possible overtimePreferred Qualifications:Any college experienceFamiliarity with Medical TerminologyExperience with ClaimsCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and 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.Keywords: UHG, St Louis, MO, customer service, healthcare, telephonic, patient interaction, appeals and grievances, call center, Optum

7 days 22 hours ago

UnitedHealth Group

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Telephonic Clinical Appeals Reviewer - St. Louis, MO UnitedHealth Group - Saint Louis, MO, United States

   

Location: Saint Louis, MO

Company Profile:
About UnitedHealth Group UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone. We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term