External Audit Appeal Analyst

This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.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 External Audit Appeal Analyst supports the UHC Appeal & Grievance External Audit Team through all phases of the external audit process. They support the Appeals & Grievances teams across our Employer & Individual and Community & State commercial groups with medical, pharmacy, dental, and vision external audits. The External Audit Appeal Analyst supports these audits through all phases of examination, from external audit launch, pre-site data and documentation gathering, sample appeal file production, onsite examiner query research and response, and examination corrective action validation. One of the role’s primary support functions is sample appeal file production, which requires working knowledge of claim and appeal processing. Engagement of our internal and external business partners in a professional manner is key to success in the role, along with an ability to influence change without authority through utilization of data analysis and subject matter expertise. Flexibility, adaptability and curiosity are critical skills for the role. This is an exciting opportunity for an analytical, diplomatic, and energetic individual to apply appeal and grievance process knowledge in a critical external audit forum.This position is full-time (40 hours/week), Monday – Friday. Employees are required to have flexibility to work either any of our 8 – hour or 4×10-hour shift schedules during our normal business hours of 6:00 am – 5:00 pm local time zone. The schedule could be flexible as long as employees work the hours per business need. It may be necessary, given the business need, to work occasional overtime or weekends.We offer on – the – job training. The duration of training will be based on the needs of each candidate. The hours of training will be aligned with your schedule. Training will be conducted virtually from your home.Primary Responsibilities:

• Support Appeals & Grievances external audits with a focus on documenting company claim and appeal processes.
• Assess and interpret external audit requests; identify solutions to non-standard requests and problems.
• Plan, manage, and support external audit appeal sample file production projects, coordinate work amongst team.
• Work independently and with minimal guidance; be a problem solver with exceptional organizational skills.
• Identify, document, and evaluate process and compliance risks escalating as needed to ensure remediation.
• Provide explanations and information to others; serve as subject matter expert internally and externally.
• Research, track, and respond to examiner inquiries; communicate complex issues in a simple, understandable, and digestible format.
• Collaborate with team members and business partners to meet external audit needs, utilizing data analysis and subject matter expertise to influence without authority.
• Professional presentation skills in a virtual forum appropriate for internal and external audiences.

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

• 4 years of appeals processing experience, including:

• An understanding of the difference between member and provider appeals, clinical and administrative reviews, and upheld vs. overturned decisions

• The ability to document full claims and appeals history / lifecycle by leveraging the appropriate systems (ETS, ATS, Doc360, claim platforms (i.e., UNET, FACETS, COSMOS), ISET, iCUE, ORS, MACESS, Maestro, etc.) to gather information, reviewing sources of truth (SOPs, SPDs, COCs, operational policies, administrative and clinical guidelines, etc.) and leveraging relationships with the supported business functions to get additional details where needed

• Experience with Adobe Professional including an understanding of basic PDF functionalities like the ability to save and print documents to Adobe PDF, using basic markup tools and the ability to collaborate using comments functions

• Experience with Microsoft Excel including the ability to filter, sort, create and edit spreadsheets; execute basic formulas; data entry and formatting

• Experience with Microsoft Outlook including the ability to manage email and calendar, and schedule meetings

• Experience with Microsoft Teams including the ability to create and manage channels, tag individuals and teams, share documents, and post announcements

• Ability to work Monday – Friday, either in any of our 8-hour or 4×10-hour shift schedules during our normal business hours of 6:00am – 5:00pm local time zone (the schedule could be flexible as long as employees work the hours per business need), including the flexibility to work occasional overtime or weekends, based on the business need

Preferred Qualifications:

• 2 years of UHC claims processing experience; inpatient, outpatient, Rx, dental / vision, etc
• Additional experience with Adobe Professional including; the ability to create, edit (including redaction), organize, and compress files into Adobe PDF binders; and the ability to navigate documents and apply / edit Adobe PDF bookmarks
• Experience with Microsoft PowerPoint including the ability to create and edit power point presentations
• Microsoft Excel skills plus the ability to create charts, graphs, pivot tables, conditional formatting, perform data validation, and advanced data analysis

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 professionally engage with internal and external business partners
• Able to analyze and investigate complex fact patterns, sought as expert to provide explanations and information within the appeals process
• Exceptional written and verbal communication and negotiation skills
• Work independently, be a problem solver, have exceptional follow-through and organizational skills
• Flexibility and adaptability; manage and prioritize competing deliverables with non-negotiable deadlines

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter PolicyPay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 – $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
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.UnitedHealth is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.#RPO

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