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Careers at UnitedHealth Group


We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

Medical and Clinical Operations



Approximate Salary:

Not Specified

Position Type:

Full Time

Clinical Appeals Reviewer - Maryland Heights, MO

UHG - Maryland Heights, Missouri

Posted: 12/7/2018

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 direct phone-based customer interaction to answer and resolve a variety of inquiries related to appeals and/or provider disputes. 

Primary Responsibilities:

  • Provide client, member and / or provider support to drive resolution of issues that may arise
  • Develop and maintain productive and positing contacts and follow - up with clients, members and / or providers either via phone, email, mail or fax 
  • Be familiar with business / industry concepts and terminology as pertains to appeals, grievances and claims processing
  • Provide consulting / education to clients based on issue/trends as it pertains the assigned appeal, grievance or claim
  • Resolve member service inquiries as it relates to the member and / or provider
  • Process telephone inquiries regarding: basic appeal rights, appeals status, general process, basic complaints, urgent appeals and claims processing, where applicable
  • Triage calls, email, fax or mail received to determine resolution type and transfer to the appropriate department, where applicable
  • Receive, process, refax or re - route letters to providers and facilities, where applicable
  • Ensure accurate documentation of all forms of communications received by clients, members and / or providers
  • Identify requests for escalation / complaints and escalate accordingly
  • Route identified issues to the appropriate site, as necessary
  • Own 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 / facility
  • Research complex issues across multiple databases and work with support resources to resolve inquiry independently
  • Participate in special projects, workgroups or committees, as assigned
  • Plans, prioritize, organize and complete work to meet established and required timeframes
  • Ensure the correct letter template is utilized when selecting the correct attachments and/or enclosure(s)
  • Fully complete system templates, as required and in accordance with internal processes
  • Send completed written notification as indicated under applicable department policies
  • Work with team to solve complex problems, where applicable
  • Work with under supervision / guidance on high level tasks with strict deadlines
  • Other duties as assigned 

Required Qualifications:

  • High School Diploma / GED (or higher)
  • 1+ years of Healthcare Insurance experience
  • Experience using a computer and Microsoft Office (MS Word, MS Excel, and MS Outlook) Ability to create, edit, copy, send and save documents, correspondence, and spreadsheets

Preferred Qualifications:

  • 1+ years of Telephonic Customer Service experience
  • Experience with ISET, IQ and / or UMR is highly desired.
  • Familiarity with Medical Terminology
  • Medical Claims experience. 

Soft Skills:

  • Effective interpersonal skills, flexibility and ability to handle change
  • Demonstrate personal resilience
  • Quality focused 
  • Excellent verbal, written, computation and organizational skills required
  • Strong time management and attention to detail
  • Excellent conflict management skills 
  • Ability to work independently as well as a member of the team
  • Must have exceptional multi - tasking skills with the ability to prioritize tasks
Ability to handle a fast pace, deadlines, and competing prioritiesExperience utilizing communication skills both verbal and written in a professional setting

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.SM

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: Optum; Optum Health; Clinical;  Appeals; Telephonic Customer Service; Reviewer

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