At UnitedHealth Group, we are a leading health care and well-being organization committed to enhancing health outcomes for millions globally. Our dynamic structure combines two key units: UnitedHealthcare and Optum, collaboratively working to revolutionize the health system. Here, your efforts will significantly contribute to the evolution of healthcare for future generations. Join us to engage with a diverse team that shares your zeal for making a difference. Together, we will embark on a journey of Caring. Connecting. Growing together.

Let’s explore the pillars of diplomacy and accuracy that have propelled UnitedHealth Group to its prestigious position among the Fortune 10 in the healthcare industry. We have achieved this by establishing ourselves as unmatched leaders in service quality and improving lives on a massive scale. Now, it’s your opportunity to create meaningful change! Channel your problem-solving skills as you take on the crucial role of reviewing, researching, and investigating denied claims to ascertain their appropriate status. You will spearhead the communication efforts with relevant stakeholders regarding appeals and grievances, and in return, we promise comprehensive training, robust support, and ample career progression opportunities.

This is a full-time position requiring a 40-hour work week from Monday to Friday. Flexibility to work any of our 8-hour shifts within our business hours (6:00 am – 5:00 pm) is essential, with potential for occasional overtime to meet business needs. This role is based in Arizona.

On-the-job training will be provided, with training hours set from 6 am to 5 pm, Monday through Friday.

If you’re situated in Arizona, you’ll enjoy the flexibility of remote work as you tackle challenging responsibilities.

Key Responsibilities:

• Thoroughly investigate and resolve written complaints from consumers and healthcare providers.

• Ensure correct categorization of each complaint.

• Gather any necessary documentation to facilitate case reviews.

• Assess cases to determine if a clinician’s review is warranted.

• Make informed, fact-based decisions for non-clinical complaints.

• Document final appeals or grievance determinations using standard templates.

• Provide timely communication regarding appeals and grievances to members, providers, and both internal and external parties.

Your contributions will be acknowledged and celebrated within a stimulating environment that guides you towards success while also offering pathways for your future career aspirations.

Essential Qualifications:

• High School Diploma / GED (or higher) or equivalent work experience.

• Must be at least 18 years old.

• Minimum of 2 years proven experience in analyzing and resolving appeals and grievances in an office setup, utilizing phones and computers, or 2 years in a healthcare environment with familiarity in medical claims or billing processes.

• Proficient in computer applications and skilled in navigating Windows PC systems, with the ability to learn new and complex applications efficiently.

• Ability to commit to full-time hours (40 hours/week) Monday to Friday, with flexibility to work any of our 8-hour shifts during business hours (6:00 am – 5:00 pm) and potential for occasional overtime.

Preferred Qualifications:

• Current employment within UHC Operations & Experience is preferred. Candidates from other units will not be considered. To verify, please check your Sparq profile and organization chart.

Remote Working Requirements:

• Residency in Arizona is required.

• Capability to maintain security for all company-sensitive documents (if applicable).

• Establishment of a dedicated workspace separate from living areas, ensuring privacy for information handling.

• Access to a UnitedHealth Group approved high-speed internet connection or an existing high-speed service is essential.

Desirable Soft Skills:

• Exceptional written communication abilities, including advanced grammar and spelling skills.

• Strong multitasking capabilities and the ability to understand multiple product lines and their respective benefits.

Please note that all remote employees are required to comply with UnitedHealth Group’s Telecommuter Policy.

The hourly compensation for this position ranges from $19.86 to $38.85 based on full-time employment. Factors such as local labor market conditions, education, experience, and certifications influence pay. UnitedHealth Group adheres to all minimum wage laws. Beyond salary, we offer a rich benefits package, incentive programs, stock purchase options, and 401k contributions, aligning with eligibility criteria. Embarking on a career with UnitedHealth Group opens up a comprehensive array of benefits and incentives.

Our mission at UnitedHealth Group is to empower individuals to live healthier lives and enhance the functionality of the health system for everyone. We believe everyone, regardless of race, gender, sexuality, age, location, or income, deserves the opportunity for optimal health. Our commitment extends to addressing health disparities, improving health outcomes, and mitigating environmental impacts – all integral to our mission.

At UnitedHealth Group, we celebrate diversity. As an Equal Employment Opportunity/Affirmative Action employer, we ensure that all qualified applicants receive fair consideration for employment irrespective of race, color, religion, sex, age, national origin, disability, veteran status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group maintains a drug-free workplace, and candidates are required to pass a drug screening prior to starting their employment.