UnitedHealthcare · 18 hours ago
Clinical Appeals Representative
Cypress, CA
Full-time
Hybrid
New Grad, Entry Level
$16.15/hr - $28.80/hr
0+ years expUnitedHealthcare is focused on simplifying the health care experience and creating healthier communities. They are seeking a Clinical Appeals Representative responsible for setting up Appeals and Grievance cases, analyzing member correspondence, and ensuring accurate handling of appeals and grievances according to regulatory requirements.
FitnessHealth CareWellness
Responsibilities
Receive appeal or grievance documentation and determine relevant details (e.g., what member is requesting)
Enter appeals and grievances details within the system and audit against provided documentation
Determine where appeal or grievance should be reviewed / handled or route to other departments as appropriate
Contact and work with other internal resources to obtain and clarify information
Complete appeal or grievance review procedures according to relevant regulatory or contractual requirements, processes, and timeframes
Qualification
Required
High School Diploma / GED
Must be 18 years of age OR older
6+ months of Telephonic Customer Service experience
Ability to use Microsoft Office, including Microsoft Word (create and edit correspondence), Microsoft Excel (ability to create, edit, and sort spreadsheets, basic analytical formulas (Vlookup)), and Microsoft Outlook (email and calendar management)
Ability to type at the speed of 35+ WPM (words per minute)
Must be available to work onsite at least three (3) days a week and may telecommute on other days if telecommuting requirements are met
Availability to work overtime as needed during peak times and as mandated by the department
Ability to work full-time (40 hours/week), Monday - Friday, in any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm PST
Preferred
Experience in Claims, Managed Care HMO, Doctor's office, and / OR Billing
Experience in a healthcare environment
Medical Terminology experience
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
H1B Sponsorship
UnitedHealthcare has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (48)
2024 (26)
2023 (45)
2022 (61)
2021 (60)
2020 (68)
Funding
Current Stage
Late StageLeadership Team
Beth Soberg
CEO West Region, Local Markets
Bobby Gregoire
Medicare Health Plan CEO, Iowa & South Dakota
Recent News
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