Clinical Appeals Reviewer - Denials Team - Multiple Locations

Company: UnitedHealth Group ( Learn More )

General Information
US-MO-St. Louis
Not Specified
Not Specified
Not Specified
Job 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.

Employees in this position are responsible for assembling and delivering written notification for Care Advocacy and Peer Reviewer issued denials within required timeframe for all levels of care for all delegated accounts. The denials may include Pre-Service and Concurrent UM and administrative requests, Post-Service cases (retrospective reviews, Clinical Claims Review) and reconsiderations.

Primary Responsibilities:

  • Retrieve work received from Care Advocacy via system work list

  • Document request in A&G denial note

  • Ensure accurate data entry

  • Prioritize work based on due date and run applicable work list reports to monitor workload

  • Plans, prioritize, organize and complete work to meet established and required time frames

  • Ensure correct letter template is utilized

  • Complete template with appropriate information and rationale

  • Select correct attachment and / or enclosure(s) and add to template

  • Send out completed written notification as indicated under applicable department policies

  • Process mail / correspondence received for retrospective reviews

  • Participates in workgroups and committees as requested

  • Solves moderately complex problems independently

  • Works with team to solve complex problems

  • Supervision / guidance is required for higher level tasks

  • Other duties as assigned

  • Required Qualifications:

  • High School Diploma / GED

  • 1+ years of healthcare insurance experience

  • Experience using a computer and Microsoft Office (Microsoft Word, Microsoft Excel, and Microsoft Outlook)

  • 6+ months of data entry experience

  • Must live in St. Louis, MO, Philadelphia, PA, San Francisco, CA, or Atlanta, GA

  • Preferred Qualifications:

  • Familiarity with medical terminology

  • Experience with medical claims

  • Any College experience

  • Telephonic customer service experience

  • Experience with ISET, IQ and / or UMR

  • Careers 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: Clinical, Appeals, Reviewer, data entry, UHG, Optum
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