Senior Clinical Appeal Reviewer - Boise, ID
Company: UnitedHealth Group
Posted on: September 10, 2023
Optum is a global organization that delivers care, aided by
technology to help millions of people live healthier lives. The
work you do with our team will directly improve health outcomes by
connecting people with the care, pharmacy benefits, data and
resources they need to feel their best. Here, you will find a
culture guided by diversity and inclusion, talented peers,
comprehensive benefits and career development opportunities. Come
make an impact on the communities we serve as you help us advance
health equity on a global scale. Join us to start Caring.
Connecting. Growing together.
This position is full-time (40 hours/week) Monday - Friday.
Employees are required to have flexibility to work any of our
8-hour shift schedules during our normal business hours of (9:00am
- 5:30pm). It may be necessary, given the business need, to work
occasional overtime. Our office is located at 322 E FRONT STREET,
Suite 400 Boise, ID 83702 -
We offer 2-3 weeks of paid training. The hours during training will
be 9:00am to 5:30pm, Monday - Friday. - Training will be conducted
in the office.
Act as a Subject Matter Expert for other team members
Manage the intake of members or the admission/discharge information
Work with hospitals, clinics, facilities, and the clinical team to
manage requests for services.
Manage the referral process, processing incoming and outgoing
referrals and prior authorizations, including intake, notification,
and census roles.
Resolve inquiries from members and/or providers.
Part of the challenge here is dealing positively with members and
providers in sometimes challenging circumstances. As a subject
matter expert, you'll also be the "go-to" resource for information.
The flexibility to work evening hours will also be required.
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.
High School Diploma / GED (or higher)
1+ years customer service experience
1+ years experience analyzing and solving customer problems
1+ years of healthcare/ insurance experience and/or social
work/community outreach/advocacy experience
1+ years of professional experience in an office setting using the
telephone and computer as the primary instruments to perform the
Work experience using Microsoft Word (edit, create & save
documents), Microsoft Excel (sorting & filtering data), and
Microsoft Outlook (email, folders, attachments, and
Ability to work any of our 8-hour shift schedules during our normal
business hours of (9:00am - 5:30pm). It may be necessary, given the
business need, to work occasional overtime.
Bachelor's degree (or higher) in social work, Public Health, or
Medicaid and / or Medicare experience
Experience working with medical terminology
Excellent Organizational Skills
Must be comfortable making outreach to members without prior
Must be able and comfortable with maintaining metrics and goals
within the department.
Must be comfortable working multiple systems on the computer
simultaneously while assisting members.
At UnitedHealth Group, our mission is to help people live healthier
lives and make the health system work better for everyone. We
believe everyone-of every race, gender, sexuality, age, location,
and income-deserves the opportunity to live their healthiest life.
Today, however, there are still far too many barriers to good
health which are disproportionately experienced by people of color,
historically marginalized groups, and those with lower incomes. We
are committed to mitigating our impact on the environment and
enabling and delivering equitable care that addresses health
disparities and improves health outcomes - an enterprise priority
reflected in our mission.
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: UnitedHealth Group, Nampa , Senior Clinical Appeal Reviewer - Boise, ID, Other , Nampa, Idaho
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