Senior Clinical Appeals Reviewer

• 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

• ME 3 and above in last review cycles
• No role or grade change in last 12 months
• Current SG 23 & 24 can apply
• SG 23 for grade up and SG 24 for lateral movement

Required Qualifications:

• Medical degree – BHMS/BAMS/BUMS/BPT/MPT/B.Sc. Nursing (Medical Graduates only)
• 1.5+ years of experience in Clinical Investigation Process W&E
• Knowledge of Clinical Waste and Error
• Knowledge of CPT/diagnosis codes, CMC guideline
• Proven good verbal and written communication skills with attention to detail & Quality focused

Preferred Qualifications:

• Health Insurance knowledge, managed care experience
• Claims processing experience
• Medical record familiarity

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.