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

Positions in this function will be responsible for researching and investigating key business problems through quantitative analyses of utilization and healthcare costs data. Develop and improve quantitative data analytics and set performance targets. The main responsibilities will include Interpret and analyze clinical data from various sources and recommend best approac

The Appeals and Grievances Medical Director is responsible for ongoing clinical review and adjudication of appeals and grievances cases for UnitedHealthcare associated companies. Performance accountabilities include Perform individual case review for appeals and grievances for various health plan and insurance products, which may include PPO, ASO, HMO, MAPD, and PDP. The