Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

Like you, UnitedHealth Group is solid on innovation. And like you, we'll go the distance to deliver high-quality care. As part of our clinical support team, you will be a key component in customer satisfaction and have a responsibility to make every contact informative, productive and positive for our members and providers. You'll have the opportunity to do live outreach, educating members about program benefits and services while also helping to manage member cases. Bring your skills and talents to a role where you'll have a chance to make an impact.

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Provides data entry, filing, tracking time frames and status of case files and mailing letters to patients and providers
• Reviews denials and determines whether the decisions are retro/claims DOS or prospective DOS, and whether they are NCB or medically necessary
• Monitors system approval queues and prints member letters, ensuring that all approvals are printed and mailed by end of business day
• Prepares envelopes and letters for mailing according to the UM policy
• Receives appeal requests from health plans and/ or QIO, logs request, researches and provides requested information
• Works with claims department to redirect claims related appeal requests
• Generates reports for analysis by department using the data entry system
• Assists with CMS organization determination reports as needed
• Must be able to work a flexible schedule that includes evening hours and holidays
  

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 or GED equivalent
• 2+ years of related experience
• Sound knowledge of medical terminology
• Proficient software computer skills
• Ability to work a 4-day flex schedule, Wednesday through Saturday, from 8am-7pm (10-hour shifts)
  

Preferred Qualifications:

• Related experience in healthcare
• Telephonic and/or telecommute experience
• Familiarity with ICD-9 coding
• Demonstrated excellent verbal and written skills
• Independent problem identification/resolution and decision-making skills
• Proven ability to possess planning, organizing, conflict resolution, negotiation, and interpersonal skills
• Demonstrated ability to interact with individuals and with multidisciplinary teams
• Ability to demonstrate excellent customer service with patients, providers, and health plan and interacting with other internal departments within the organization
  

Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York, Rhode Island or Washington residents is $16.00 to $31.44. 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.

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.