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Optum Appeals Jobs (NOW HIRING)

UnitedHealth Group

Clinical Appeals RN

Boston, MA · On-site

$28.94 - $51.83/hr

Optum is a global organization that delivers care, aided by technology, to help millions of people ... The Clinical Appeals RN is responsible for attending appeal hearings, defending MassHealth prior ...

UnitedHealth Group

Clinical Appeals RN

Boston, MA · Remote

$28.94 - $51.83/hr

Optum is a global organization that delivers care, aided by technology, to help millions of people ... The Clinical Appeals RN is responsible for attending appeal hearings, defending MassHealth prior ...

UnitedHealth Group

Pharmacist PA/Appeals

Houston, TX · Remote

$55.75 - $66.75/hr

Pharmacist PA/Appeals - Remote Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...

UnitedHealthcare

Pharmacist PA/Appeals

$59.50 - $71.75/hr

Pharmacist PA/Appeals - Remote Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...

New

UMR

Pharmacist PA/Appeals

$59.50 - $71.75/hr

Pharmacist PA/Appeals - Remote Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...

Genoa Telepsychiatry

Pharmacist PA/Appeals

$59.50 - $71.75/hr

Pharmacist PA/Appeals - Remote Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...

Reliant Medical Group

Pharmacist PA/Appeals

$59.50 - $71.75/hr

Pharmacist PA/Appeals - Remote Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...

New

divvyDOSE

Pharmacist PA/Appeals

$59.50 - $71.75/hr

Pharmacist PA/Appeals - Remote Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...

UnitedHealth Group

Pharmacist PA/Appeals

Houston, TX · Remote

$55.75 - $66.75/hr

Pharmacist PA/Appeals - Remote Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly ...

UMR

Senior Pharmacy PA/Appeals Technician

Senior Pharmacy PA/Appeals Technician Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will ...

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Optum Appeals information

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$14

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$56

How much do optum appeals jobs pay per hour?

As of Aug 6, 2026, the average hourly pay for optum appeals in the United States is $28.06, according to ZipRecruiter salary data. Most workers in this role earn between $15.62 and $35.10 per hour, depending on experience, location, and employer.

What is the difference between Optum Appeals vs Optum Claims Processor?

AspectOptum Appeals

Optum Appeals specialists focus on reviewing and contesting denied claims, requiring knowledge of insurance policies, medical billing, and healthcare regulations. They handle complex cases, communicate with providers and insurers, and ensure proper claim resolution. In contrast, Optum Claims Processors primarily process and input claims, verify data accuracy, and ensure timely submission. While both roles require familiarity with healthcare billing and insurance procedures, Appeals roles demand analytical skills and understanding of denial reasons. Both positions are essential in healthcare claims management, but Appeals specialists handle more complex, contested cases.

What are some common challenges faced by professionals in Optum Appeals roles, and how can they be addressed?

Professionals working in Optum Appeals often encounter challenges such as managing high caseloads, navigating complex regulatory requirements, and ensuring timely resolution of appeals. Staying organized, leveraging available technology tools, and maintaining clear communication with both internal teams and external stakeholders are essential strategies for success. Additionally, ongoing training and collaboration with experienced colleagues can help in understanding evolving healthcare policies and improving outcomes for members.

What are the key skills and qualifications needed to thrive as an Appeals Specialist at Optum?

To thrive as an Appeals Specialist at Optum, you generally need a background in healthcare administration, knowledge of insurance claims processes, and familiarity with medical terminology, often supported by a degree or relevant experience. Expertise with claims management systems, Microsoft Office Suite, and sometimes certifications like Certified Professional Coder (CPC) are commonly expected. Strong analytical thinking, attention to detail, and effective written and verbal communication are standout soft skills in this position. These competencies are vital for accurately reviewing, processing, and communicating appeals decisions, ensuring compliance and positive outcomes for both the organization and patients.

What is an Optum Appeals?

Optum Appeals refer to the process of challenging or disputing health insurance claim denials managed by Optum, a healthcare services company. When a claim for medical services is denied, patients or providers can submit an appeal for reconsideration. The appeals process involves reviewing the initial decision, providing additional documentation if necessary, and ensuring that the claim is evaluated according to policy guidelines and regulations. Optum Appeals Specialists are responsible for navigating this process, communicating with clients, and ensuring timely resolution of appeals.
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What states have the most Optum Appeals jobs? States with the most job openings for Optum Appeals jobs include:
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Optum Appeals jobs near you
Infographic showing various Optum Appeals job openings in the United States as of August 2026, with employment types broken down into 90% Full Time, 8% Part Time, and 2% Contract. Highlights an 81% Physical, 6% Hybrid, and 13% Remote job distribution, with an average salary of $58,373 per year, or $28.1 per hour.

Clinical Appeals RN

UnitedHealth Group

Boston, MA • On-site

$28.94 - $51.83/hr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 2 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

188th of 887 rated healthcare providers

Job description

Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come makes an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The Clinical Appeals RN is responsible for attending appeal hearings, defending MassHealth prior authorization decisions, and performing pre-service/prior authorization clinical coverage review of services. Works closely with managers and peers.
If you currently reside in the state of Massachusetts, you'll enjoy the flexibility to telecommute* as you take on some tough challenges.
Primary Responsibilities:
  • Represent MassHealth at appeal hearings
  • Defend MassHealth prior authorization decisions by utilizing program specific regulations, medical necessity guidelines, standards of care and best practices
  • Represents the MA MLTSS program in a positive, solution-focused manner that embodies our corporate values: Integrity, Compassion, Relationships, Innovation and Performance
  • Determine the appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination
  • Identify solutions to non-standard requests and problems
  • Participate in regular meetings to collaborate with supporting leadership and team to ensure operational efficiency
  • Assures performance adheres with established quality standards, evidenced based practice guidelines and departmental benchmarks and workflows
  • Act as a resource for others; provide explanations and information on difficult issues
  • Minimum 10% travel within the state of MA

What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
  • Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
  • Medical Plan options along with participation in a Health Spending Account or a Health Saving account
  • Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
  • 401(k) Savings Plan, Employee Stock Purchase Plan
  • Education Reimbursement
  • Employee Discounts
  • Employee Assistance Program
  • Employee Referral Bonus Program
  • Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • Associate's degree in Nursing
  • Unrestricted RN license required in the state of Massachusetts
  • 3+ years of Managed Care and/or clinical experience
  • Designated workspace and access to install secure high-speed internet via cable or DSL in home
  • Reside in the state of Massachusetts

Preferred Qualifications:
  • Prior-Authorization experience
  • Utilization Management experience
  • Appeals Experience
  • Medicare/Medicaid experience preferred
  • Proficient with Microsoft Office programs, including Word, Excel, PowerPoint
  • Excellent communications skills, including the ability to write clearly, succinctly and in a manner that appeals to a wide audience
  • Excellent time management, organizational, and prioritization skills with ability to balance multiple priorities

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.94 to $51.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
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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