Appeals Representative Associate

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.

Appeals redressal – to make informed and well researched decision to overturn or uphold claims/authorization requests decision on member/provider appeal requests

This process operates 24/7 due to its stringent turnaround time on expedited appeals which is around 6 to 72 hours. 

Primary Responsibilities:

• Appeals resolution with high accuracy and timeliness to ensure individual and business metrics are met
• Conducts research in claims history and coordinates with business partner to make decision to uphold or overturn claims decision
• Read and comprehend incoming appeals and supporting documentation
• Read and comprehend written operating procedural steps
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, change in teams and/or work shifts, policies in regard to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment).The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Graduation (BTECH / BE / MBA / B pharm / M pharm / BCA / MCA are not eligible to apply)
• Proven good communication skills written and verbal
• Proven good typing speed (English) and accuracy
• Proven result-oriented and goal-driven 
• Ready to work in late night shifts (6 PM & 9 PM login) & to work on weekends
• Work from Office and rotational shifts

Preferred Qualification:

• US Healthcare experience advantage

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.