Positions in this function are responsible for reviewing, researching, investigating, and triaging all types of appeals and grievances. Communicates with appropriate parties regarding appeals and grievance issues

Primary Responsibilities:

• Ensure complaint has been categorized correctly
• Determine and confirm member eligibility and benefits
• Obtain additional documentation required for case review
• Place relevant documents into image repository
• Initiate outbound contact to members or providers
• Review case to determine if review by Clinician is required
• Research and resolve written complaints submitted by consumers and physicians/providers
• Render decision for non-clinical complaints using sound, fact-based decision making
• Draft verbiage for use in outbound correspondence
• Prioritize and organize tasks to meet compliance deadlines
• Ability to meet established productivity, schedule adherence, and quality standards

Requirements:

• High school diploma or GED
• 1+ year of customer service experience analyzing and solving customer problems; OR 1+ year of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties required
• Proficiency in MS Office applications (Word, Excel & Outlook) is required
• Experience with Healthcare/Medical/Pharmacy terminology highly preferred
• Strong customer service orientation
• Strong communication/telephone skills
• Sound decision making skills
• Ability to navigate multiple computer systems.

UnitedHealth Group is working to create the health care system of tomorrow. 

Already Fortune 25, we are totally focused on innovation and change.  We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we’re doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we’re building a high-performance health care system that works better for more people in more ways than ever. Now we’re looking to reinforce our team with people who are decisive, brilliant – and built for speed.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.