UnitedHealthcare · 1 day ago
Clinical Appeals Reviewer
United States
Full-time
Remote
Entry Level
$17.98/hr - $32.12/hr
2+ years expUnitedHealthcare is dedicated to simplifying the health care experience and creating healthier communities. The Clinical Appeals Reviewer role involves ensuring complaints are categorized correctly, determining member eligibility, and managing documentation for case reviews. This position requires strong organizational skills and the ability to prioritize tasks to meet compliance deadlines.
FitnessHealth CareWellness
Responsibilities
Ensure complaints have been categorized correctly
Determine and confirm member eligibility and benefits
Obtain additional documentation required for case review
Place relevant documents into image repository
Initiate outbound contact to members or providers
Review case to determine if review by Clinician is required
Research and resolve written complaints submitted by consumers, physicians / providers
Render decision for non - clinical complaints using sound, fact - based decision making
Prioritize and organize tasks to meet compliance deadlines
Ability to meet established productivity, schedule adherence, and quality standards
Moderate work experience within own function
Some work is completed without established procedures
Basic tasks are completed without review by others
Supervision / guidance is required for higher level tasks
Qualification
Required
High School Diploma / GED OR equivalent work experience
Must be 18 years of age OR older
2+ years of customer service/call center experience
Ability to work full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work on any of our 8-hour shift schedules during our normal business hours of 9:00am - 6:00pm CST. It may be necessary, given the business need, to work weekends, holidays, and occasional overtime
Preferred
Experience with DOC360, ETS, HSR, UNET, ISET, CIRRUS
Experience with working on Appeals / Intake
Experience within Clinical Advancement
Experience working with Microsoft Office including Microsoft Outlook (ability to create, edit, save, and send documents) and Microsoft Excel (ability to create, edit, save, and send documents)
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
UnitedHealthcare
UnitedHealthcare helps people live healthier lives by simplifying the health care experience.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Beth Soberg
CEO West Region, Local Markets
Bobby Gregoire
Medicare Health Plan CEO, Iowa & South Dakota
Recent News
MedCity News
2026-02-04
NH Business Review
2026-02-04
2026-02-03
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