Clinical Appeals Consultant

2 days ago

Makati City, National Capital Region, Philippines Optum, a UnitedHealth Group Company Full time $90,000 - $120,000 per year

ROLE AND RESPONSIBILITIES

  • Position in this function includes those responsible for management and administration of multiple Medical & Clinical Operations Functions, or managing general operations which are not specific to one of the functions in the Medical & Clinical Operations job family.
  • Provides leadership to and is accountable for the performance of managers and/or senior level professional staff. Impact of work is most often at the operational or local business unit or market level.
  • Owns an end-to-end process. Develops functional, market level, and/or site strategy, plans, production and/or organizational priorities. Identifies and resolves technical, operational and organizational problems outside own team. Product, service or process decisions are most likely to impact entire functions and/or customer accounts.
  • Engage members over the phone to have a discussion about their health -Review available member service records and relevant documentation (e.g., utilization history, functional level, stratification information, current plan of care). Conduct comprehensive member assessment that includes bio-psychosocial, functional, and behavioral health needs. Utilize interviewing techniques and active listening to collect and retain member information and incorporating responses as they are presented to complete assessment

QUALIFICATIONS:
- must be Internal Medicine Diplomate with active medical license
- Willing to work onsite in Makati City or Muntinlupa City (hybrid)
- Willing to work night shifts and in a hybrid work arrangement

WHAT WE OFFER:
- Market Competitive Pay Levels
- Retirement Plan
- Medical Plan (HMO) from Day 1 of employment
- Dental, Medical, and Optical Reimbursements
- Life and Disability Insurance
- Paid Time-Off Benefits
- Sick Leave Conversion
- Tuition Fee Reimbursement
- Employee Assistance Program (EAP)
- Annual Performance Based Merit Increases
- Employee Recognition
- Training and Staff Development
- Employee Referral Program
- Employee Volunteerism Opportunity
- All Mandatory Statutory Benefits

WHO WE ARE:

  • Optum is the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare.
  • UnitedHealth Group is a health care and well-being company with a mission to help people live healthier lives and help make the health system work better for everyone.
  • We're a leading health solution and care delivery organization. Our work is complex, but our mission is simple: create a healthier world, with you at the center.
  • As part of a Fortune 4 enterprise, we are improving the health care experience of over 125 million people around the world.
  • We're a diverse team with operations across North America, South America, Europe, Asia Pacific and the Middle East. This includes our over 25,000 employees in the Philippines.
  • Elevate your career with a leading health care company while improving lives.

Join us in evolving health care so everyone can have the opportunity to live their healthiest life. This is your opportunity to be part of a team that's dedicated to Caring. Connecting. Growing together

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