Welcometo one of the toughest and most fulfilling ways to help people, includingyourself. We offer the latest tools, most intensive training program in theindustry and nearly limitless opportunities for advancement. Join us and startdoing your life's best work.(sm)Optum,part of the UnitedHealth Group family of businesses is working to create the health care system of tomorrow.Already Fortune 06, we are totally focused on innovation and change. We work alittle harder. We aim a little higher. We expect more from ourselves and eachother. And at the end of the day, we're doing a lot of good.Through our family of businesses and a lot of inspired individuals, we'rebuilding a high-performance health care system that works better for morepeople in more ways than ever. Now we're looking to reinforce our team withpeople who are decisive, brilliant and built for speed.Positions in this function are responsible for reviewing, researching,investigating, and triaging all types of appeals and grievances. This role communicateswith appropriate parties regarding appeals and grievance issues.Primary Responsibilities:Ensure complaint has beencategorized correctly Determine and confirm membereligibility and benefits Obtain additional documentationrequired for case review Place relevant documents into imagerepository Initiate outbound contact to membersor providers Review case to determine if reviewby Clinician is required Research and resolve writtencomplaints submitted by consumers and physicians/providersRender decision for non-clinicalcomplaints using sound, fact-based decision making Draft verbiage for use in outboundcorrespondence Prioritize and organize tasks tomeet compliance deadlines Ability to meet establishedproductivity, schedule adherence, and quality standards
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.