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IRE Validation Analyst - Cypress, CA

UnitedHealth Group

Cypress, CA
Job Code:
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Job Details

IRE Validation Analyst - Cypress, CA(Job Number:706685)

Position Description:

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.

Flexible, Friendly, Fast on your feet, that's a great start. Accurate, Accountable, Self-Directed, these traits can take you places. Our claims operations are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's a fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused.

Positions in this function are responsible for all aspects of quality assurance within the Claims job family. Conducts audits and provides feedback to reduce errors and improve processes and performance.

Primary Responsibilities:

  • Provide appeals support by reviewing, researching, investigating, and auditing Part C and or D appeal cases
  • Review approve/deny Maximus Packet after audit review conducted and ensure the packets are of high quality before sending to the Independent Review Entity (IRE)
  • Work with Business Partners to research/resolve/update issues
  • Provide feedback to team members on audit results
  • Create Case files for Dismissal Case File Requests from the Independent Review Entity (IRE)
  • Document applicable systems and update Adobe PDF documents
  • Analyze and identify trends and provide feedback
  • Responsible for all aspects of quality assurance
  • Analyze information and utilize to build recommendations to reduce errors and improve process performance
  • Contact IRE Liaison as needed
  • Assist with IRE inquires and provide high quality responses in a timely manner
  • Assist with other IRE projects as assigned

Job Claim Quality
Primary Location US-CA-Cypress
Other Location 
Organization M&R Ops - M&R Appeals
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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