Job Description

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.
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.
The Appeals Representative Associate is responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances.
Primary Responsibilities:

• Research and resolve written complaints and complex or multi-issue provider complaints submitted by consumers and physicians/providers
• Communicate with appropriate parties regarding appeals and grievance issues, implications and decisions
• Analyze and identify trends for appeals and grievances
• Apply knowledge/skills to basic, repeated activities
• Respond to standard requests and solve routine problems by following established procedures
• Work with others as part of a team and have work reviewed by others
• 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, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards 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

• High school diploma or GED or equivalent experience
• 1+ years of customer service experience in a call center environment analyzing and solving customer problems OR 1+ years of experience in a corporate environment
• Beginner level of experience with MS Word and Excel
• Proven ability to work overtime as needed

• Experience with Healthcare/Medicare terminology
• Managed Care and previous Appeals/Grievances experience