Provider Appeals Subject Matter Expert (E&I) – National Remote

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.
As a Provider Appeals Subject Matter Expert (E&I) you will provide support as a technical resource to RAs, Supervisors, and Business Managers to resolve complex issues. The SME must perform all job tasks with ease and confidence and demonstrate a high level of performance in a team environment, serving as a positive role model. The SME will review, analyze and resolve ETS issues, as necessary, to maintain acceptable service levels.
This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 6:00pm CST. In addition, employees are required to participate in Saturday rotations. It may be necessary, given the business need, to work occasional overtime.
We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:

Act as point of contact for RAs with technical questions

Act as technical support to RAs, Supervisors and Business Managers for escalated issues

Assist and observe RAs with complex issues as assigned by Supervisor/Business Manager

Act as a resource on projects as assigned by leadership

Review and provide coaching on RA opportunities

Assist in developing Huddle Topics as needed based on weekly QA trends identified by Supervisor

Assist with resolving ETS cases as identified by Supervisor

Provide training and support as required

Conduct presentations and facilitate meetings (i.e., quality huddles, coaching sessions, trainings, etc.)

Conduct side-by-side observation sessions with RAs identified by Supervisor as needing improvement

Observe RA and gather feedback, focusing on specific areas as defined by Supervisor

Provide Side-by-Side Summary to Supervisor by end of day in which side-by-side was conducted

Participate in weekly SME calls to discuss RA trends, Huddle Topics and share best practices

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 / GED or equivalent work experience

Must be 18 years of age or older

1+ years of experience in appeals

Experience with Microsoft Excel (create and edit spreadsheets) and Microsoft Word (create and edit documents)

Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 6:00pm CST

Telecommuting Requirements:

Ability to keep all company sensitive documents secure (if applicable)

Required to have a dedicated work area established that is separated from other living areas and provides information privacy.

Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

Ability to manage multiple projects

Meeting all metrics and not on a coaching or corrective action plan (Quality, Efficiency, Idle/lock, etc)

Have a high knowledge base in the LOB you are applying for

Individual engagement in team activities in a collaborative environment

Ability to work independently with little follow-up

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR Washington, D.C. Residents Only: The hourly range for this is $23.22 – $45.43 per hour. 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.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.
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UnitedHealth Group