Location: Dallas, TX
Cap-Exempt H-1B Position — No lottery required
*This position is National Remote. You'll enjoy the flexibility to telecommute\\* from anywhere within the U.S. as you take on some tough challenges.* **Optum Insight** is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start **Caring. Connecting. Growing together.** This position is full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 5:00 pm MST. We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule. **Primary Responsibilities:** - Research and resolve written complaints submitted by consumers and physicians / providers - Ensure complaint has been categorized correctly - Obtain additional documentation required for case review - Review case to determine if review by clinician is required - Render decision for non-clinical complaints using sound, fact-based decision making - Complete necessary documentation of final appeals or grievance determination using appropriate templates - Communicate appeal or grievance information to members or providers and internal/external parties within the required timeframes 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 OR equivalent years of work experience - Must be 18 years of age OR older - 1+ years of experience with analyzing and solving customer problems - 1+ years of exp