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Job Details


UnitedHealth Group

Senior Appeals Representative - San Diego, CA

Healthcare

All

Yearly

Full Time

No

San Diego, California, United States

If you are located in a commutable distance of San Diego, CA you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.

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 5 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 & Performance.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:00am – 9:00pm Pacific Standard Time, Monday-Friday. It may be necessary, given the business need, to work occasional overtime.

Our office is located at 3131 Camino Del Rio San Diego, CA. Employees will be required to work 3 days onsite and 2 days from home. (5 days in office accommodation, if desired)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

  • Demonstrate exceptional service in every internal and external interaction by anticipating customer requirements and meeting or exceeding them consistently
  • Assess issues where stakeholders are reporting claims payment problems, including claims and data analysis
  • Health processes the issue may have occurred and what the root cause is
  • Create and execute action plan to achieve resolution including partnering with internal and external stakeholders to address process gaps, process failures and human error
  • Communicate status of issue resolution to internal and external stakeholders
  • Document case actions in RICHE/ARCHE. Complete notices to members and providers as required by law and within required timeframe's if the case was received as a formal complaint or appeal
  • Other duties including data entry, typing, photocopying, and filing as needed to support job responsibilities

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)
  • 2+ years of experience analyzing and solving appeals and grievances in an office environment using the telephone and computer as the primary instruments to perform 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 complex computer system applications
  • Ability to work full-time, Monday - Friday between 6:00am – 9:00pm Pacific Standard Time, including the flexibility to work occasional overtime
  • Ability to work a HYBRID schedule: in office 3 days; home 2 days a week. (5 days accommodation onsite, if desired)
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation.

Telecommuting Requirements:

  • Reside within a commutable distance of San Diego, CA
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

  • Ability to work well across different sections of the company
  • Excellent oral/written communication skills
  • Anticipates customer needs and proactively identifies solutions
  • Solves complex problems on own; proactively identifies new solutions to problems.
  • Detail-oriented and excellent organizational skills.
  • Demonstrated ability to prioritize and manage multiple tasks

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at [Register to View]

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. [Register to View]

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: #RPO, #RED