If you are located within Eastern Standard Time Zone, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work . SM

Supports the investigation, coordination and resolution of all member grievances, appeals, provider appeals and related complex issues, including State Fair Hearings. Ensures that these issues are resolved within the mandatory guidelines as established by state and federal regulatory agencies, accrediting organizations standards, and in accordance with MCNA’s Grievance and Appeals Department policies and procedures.

This position is full - time. Employees are required to work our normal business hours of 8:00 AM - 5:00 PM. Training will be conducted virtually from your home.

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

Primary Responsibilities:

• Reports directly to the Grievances and Appeals Supervisor - North
• Research and resolves member complaints, grievances , appeals and provider appeals involving provision of service and benefit coverage issues, ensuring compliance with MCNA Grievance and Appeals policies and procedures
• Contacts members and providers to gather information and communicate disposition of case; documents interactions
• Maintain grievance and appeals case files in the Grievance and Appeals module
• Communicate with members, providers and contracted health plans verbally or in writing
• Prepare summaries and write resolution letters for members and providers, which include summarizing member grievances or appeals and steps taken to resolve their issue in clear and grammatically correct language
• Prepare files for appeals to regulatory agencies
• Communicates with SAP, Medicaid Fair Hearing according to contract requirements
• Maintain current on all regulatory requirements as they apply to grievance and appeal processes
• Maintain the confidentiality of all sensitive documents, records, discussions and other information generated in connection with any grievance or appeal, make no disclosures of such information except to persons authorized to receive it in the conduct of business
• Participate in Quality Improvement activities
• Participate in grievance and appeals orientation of new employees
• Collaborate with internal departments, such as, Member Services, Provider Relations and Dental Management departments with grievance and appeals
• Oversees the maintenance of grievance and appeals logs and files

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 related experience, which include customer service in a managed care environment, medical office, OR health insurance
• 1+ years of prior grievance and appeals experience
• Ability to work any 8-hour shift between the hours of 8:00 AM - 5:00 PM

Preferred Qualifications:

• Bachelor’s Degree (or higher) in business, finance, OR healthcare administration
• Prior Medicaid experience

Telecommuting Requirements:

• Reside within Eastern Standard Time Zone
• 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:

• Strong oral and written communication

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 https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers at UnitedHealthcare Employer & Individual . We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life’s best work. SM

Connecticut or New York City Residents Only: The salary range for Connecticut / New York City residents is $16.83 - $29.66. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

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