Arizona State Fair Hearing Analyst - Remote in AZ

UnitedHealth Group is a health care and well-being company that's dedicated to improving the health outcomes of millions around the world. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others. Join us to start Caring. Connecting. Growing together.

You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength, and attention to detail. In return, we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work.

This position falls within our Community & State Appeals and Grievances Department. You will consult with staff, including but not limited to QM (Quality Manager), Provider relations staff, Medical Management (including Prior Authorization), Member services, and Compliance / Legal.

Primarily you will be assigning cases, tracking / trending inventory, and hearing volumes. You will also analyze this data. Position performs claims, provider network, and State regulator contract and rules research and data mining. Position is responsible for the timely and accurate investigation of Grievance System administrative and compliance with State contracts requirements. Accordingly, to investigate, file creation, attending staffing for member grievances and appeals and provider claims disputes.

This position is full time, Monday - Friday. Employees are required to work within standard business hours of 8:00 AM - 5:00 PM, with the flexibility to work evenings or weekends as business needs arise.

We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule.

If you are located within the state of Arizona, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Helps in data and report (trending) preparation to meet health plan and State timeliness requirements.
• Review of incoming mail, logging and assigning cases to coordinators
• Facilitating and preparing for weekly and monthly SFH (State Fair Hearing) meetings to include agenda, copies, invites
• Prepare for review, responses to subpoenas, garnishments, record requests, liens, etc.
• Prepare for review, responses to subpoenas, garnishments, record requests, liens, etc.
• Familiarity with Federal and State laws, regulations, including A.A.C. Title 9, Chapters 34, State Medicaid policies, procedures, reimbursement, etc.
• Maintain internal logs and prepare reports for health plan management and meeting State submission requirements
• Assist in developing, implementing and timely preparing system reports and analysis
• Investigate member appeals to assist in rendering timely and accurate decisions within AHCCCS mandated criteria and within production and quality standards
• Schedule and assist in preparation of witness (e.g., Medical Director) and arrange for appearance / telephonic requests of witnesses as well as exhibit gathering
• Assists in preparation for and presentation of Medicaid grievances and claim disputes towards timely resolution, up to and including, in administrative hearings on government-funded managed health care programs: AHCCCS, DDD, Evercare and CRS matters
• Conduct pre-administrative hearing investigation for appeals and claim disputes, document the findings (in the appeal files), help identify common factors as to whether appeal or claim dispute is a candidate for settlements and assist in settlement negations, as needed
• Assists with filing Grievances and Appeals / Claim Dispute / request State Fair Hearing process; distinguishing between an inquiry, a Grievance, an Appeal, a Claim Dispute, and a quality-of-care issue and know how to triage, resolve, or refer incoming calls / correspondence to appropriate personnel
• Docket hearing notices, contact State / Office of Administrative hearings, establish duties and timeframes in connection with each hearing and disseminate information with follow-up as appropriate
• Provide testimony on behalf of the health plan and administrative hearing and represent the health plan at hearing when necessary and appropriate
• Assists with internal segment and external vendor coordination, e.g., third-party liability, lien, primary insurance / coordination of benefit issues, questions
• Other duties as assigned by manager

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
• Must be 18+ years of age or older
• 3+ years of experience in either State Fair Hearing (SFH) or Appeals and Grievances
• 3+ years of advanced professional reporting experience within Microsoft Excel including the ability to easily create pivot tables, VLOOKUP, and work with large data sets
• 1+ years of experience preparing professional, data-driven narrative reports for all staff levels
• 1+ years of experience utilizing Microsoft Word (create and edit documents)
• 1+ years of experience utilizing Microsoft Outlook (send, receive emails, and manage calendar)
• Ability to work within standard business hours of 8:00 AM - 5:00 PM, Monday - Friday with the flexibility to work evenings or weekends as business needs arise

Preferred Qualifications:

• State Fair Hearing (SFH) experience or exposure
• Experience tracking and analyzing data
• Experience managing incoming court documents
• Experience managing work queue or assigning work to a team of 5 or greater
• Presently employed within UHC Operations & Experience. Those currently employed outside that unit will not be considered. (To verify, review your Sparq profile and the organization chart. Sparq Homepage, click "My Profile", click "Organization Chart". Look upward on the org chart to confirm that you report through Ops & Experience, and Mike Baker)

Telecommuting Requirements:

• Reside within the state of Arizona
• 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:

• Strong organizational and analytical skills
• Ability to balance conflicting priorities
• Ability to communicate in a concise, professional manner

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The salary range for this role is $59,500 to $116,600 annually based on full-time employment. 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.

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 Group 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.

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