Description:Position Description:Energize your career with one of Healthcare’s fastest growing companies.    You dream of a great career with a great company – where you can make an impact and help people.  We dream of giving you the opportunity to do just this.  And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.  We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: Optum –a growing part of our family of companies that make UnitedHealth Group a Fortune 14 leader.  Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life’s best work.The Clinical Appeals Investigator will work with a team on researching issues to determine feasibility of reducing medical costs through prospective solutions of claim system processes and claim business rules. Primary Responsibilities:Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization.Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance Use pertinent data and facts to identify and solve a range of problems within area of expertise Responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. May conduct contestable investigations to review medical history.Generally work is self-directed and not prescribed.Works with less structured, more complex issues.Serves as a resource to others.Qualifications:Requirements: High School Diploma/GEDMust be a current Certified Coder or a current Registered Nurse/Licensed Practical NurseExperience working with medical claimsExperience in HealthcareExperience with Microsoft Excel – Creating/Updating SpreadsheetsAssets: Bachelor’s Degree1+ years of experience with claims auditing and researching claims informationKnowledge of claims processing systems and guidelines/processesKnowledge of Medicaid/Medicare Reimbursement methodologies Anti-fraud principle knowledge  Experience with Microsoft Access – Ability to look up and review informationPhysical Requirements and Work Environment:Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activityCareers with Optum. Here’s the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.SM Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or _expression, marital status, genetic information, or any other characteristic protected by law. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Travel: No CitizenshipStatus: Other Visa Accepted Function: Claim Recovery/Resol/COB/SubroBusinessSegment: Optum Operations Division: Optum Ops-Payment Integrity DeliveryModel: Gold ContestNumber: 662692 Shift: Day Job OvertimeStatus: Non-exempt