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Clinical Appeals Reviewer - Schaumburg, IL, Philadelphia, PA, St Louis, MO, San Francisco, CA or Atlanta, GA only

UnitedHealth Group

Schaumburg, IL
Job Code:
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Job Details

Clinical Appeals Reviewer - Schaumburg, IL, Philadelphia, PA, St Louis, MO, San Francisco, CA or Atlanta, GA only(Job Number:729156)

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.

Primary Responsibilities:

  • Triage requests into correct categories
  • Document request as A & G Correspondence or A & G Appeal
  • Operate with high attention to detail when performing various data entry tasks
  • Prioritize work based on due date and run applicable work list reports to monitor workload
  • Plan, prioritize, organize and complete work to meet assigned deadlines
  • Determine if appeal is clinical or administrative and ensure correct letter template is utilized
  • Select, update and send department specific attachments and / or enclosure(s)
  • Send out written notification as indicated under appeals policies compile IRO packets
  • Solve moderately complex problems individually or in a team setting
  • Work on high level tasks under management supervision / guidance
  • Adhere to state and federal guidelines with processing appeals
  • Handle high claims and appeal volume while using internal Claim, UM / UR Behavioral Health, Medical claims / appeal management processes

Job Clinical Appeals
Primary Location US-IL-Schaumburg
Other Location US-CA-San Francisco, US-GA-Atlanta, US-PA-Philadelphia, US-MO-St. Louis
Organization Optum Ops-PHM Utilization Mgmt
Schedule Full-time
Number of Openings 1
Apply on the Company Site

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.

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