Dispute and Appeals Manager - Remote in Idaho
Company: UnitedHealth Group
Location: Boise
Posted on: March 12, 2025
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Job Description:
UnitedHealthcare Community & State is excited to serve more
members in Idaho and is seeking dedicated professionals to be part
of our team. If you are enthusiastic about making an impact in
healthcare, learn more at our upcoming Virtual Career Event, on
March 11th, 12:00-2:00MDT.
Register to attend:
At UnitedHealthcare, we're simplifying the health care experience,
creating healthier communities and removing barriers to quality
care. The work you do here impacts the lives of millions of people
for the better. Come build the health care system of tomorrow,
making it more responsive, affordable and equitable. Ready to make
a difference? Join us to start Caring. Connecting. Growing
together.
The Dispute and Appeals Manager will adjudicate member grievances
and appeals, including coordination of requests for state fair
hearings. The Dispute and Appeals Manager is qualified by training
and experience to process and resolve grievances and appeals and is
responsible for the grievance system.
This is a fast-paced working environment that requires the ability
to multitask with attention to detail and excellent organizational
skills.
If you are located in Idaho, you will have the flexibility to work
remotely* as you take on some tough challenges.
Primary Responsibilities:
The Dispute and Appeals Manager roles and responsibilities
include:
Analyze/research/understand how a service/procedure/authorization
was processed and why it was denied/modified
Obtain relevant medical records to submit appeals or grievance for
additional review, as needed
Leverage appropriate resources to obtain all information relevant
to the claim modified or denied service
Identify and obtain additional information needed to make an
appropriate determination
Obtain/identify contract language and processes/procedures relevant
to the appeal or grievance
Work with applicable business partners, shared services, providers
and members to obtain additional information relevant to the
denied/modified service (e.g. Utilization Management/Prior
Authorization)
Determine whether additional appeal or grievance reviews are
required (e.g., medical necessity), and whether additional appeal
rights are applicable
Determine where specific appeals or grievances should be
reviewed/handled, and route to other departments as appropriate
Identify and obtain additional information needed to make an
appropriate determination
Ensure that members obtain a full and fair review of their appeal
or grievance
Document final determination of appeals or grievances using
appropriate templates, communication processes, etc. (e.g.,
response letters, Customer Service documentation)
Completes member, provider and regulatory grievances and appeals
cases within the specified time frame
Prepares grievance and appeals cases for presentation to triage and
resolution teams
Works with internal departments to resolve grievances and
appeals
Acts as liaison with regulatory agencies regarding member
grievances and appeals
Understand and adhere to applicable documentation handling policies
and regulations (e.g., document security, retention)
Assist with validation of monthly/quarterly State appeal and
grievance reporting
Attend and participate at State meetings
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:
2+years of experience with appeals, grievances and member
complaints
Experience gathering documentation and presenting case facts to
Administrative Law Judge at state fair hearings
Beginning to intermediate experience in Microsoft Office
applications
Familiarity and fluency with computer and Windows PC applications,
which includes the ability to learn new and complex computer system
applications
Proven ability to compose written correspondence free of
grammatical errors while also translating medical and insurance
expressions into simple terms that members can easily
understand
Ability to work Monday - Friday and flexibly outside core hours,
including evenings and weekends, per business needs
Resident of Idaho
Preferred Qualifications:
Experience with Medicare and/or Medicaid and managed care in a
variety of health care settings
Experience working with state partners
Experience working in a member facing role
Proven ability to remain focused and productive each day though
tasks may be repetitive
Proven ability to multi-task, including the ability to understand
multiple products and multiple levels of benefits within each
product
*All employees working remotely will be required to adhere to
UnitedHealth Group's Telecommuter Policy.
The salary range for this role is $59,500 to $116,600 annually
based on full-time employment. Pay is based on several factors
including but not limited to local labor markets, education, work
experience, certifications, etc. UnitedHealth Group complies with
all minimum wage laws as applicable. 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.
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, Boise , Dispute and Appeals Manager - Remote in Idaho, Executive , Boise, Idaho
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