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IRE Validation Analyst - Cypress, CA or Telecommute in CA only

UnitedHealth Group

Cypress, CA
Job Code:
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Job Details

756243 IRE Validation Analyst Cypress CA or Telecommute in CA only

IRE Validation Analyst - Cypress, CA or Telecommute in CA only (756243)

Position Description

The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. In this role, you'll be responsible for all aspects of quality assurance within the claims job family including conducting audits and providing feedback to reduce errors and improve processes and performance. Join us and build your career with an industry leader.

IRE Validation Analysts are responsible for all aspects of quality assurance within the Claims job family, conducting audits and providing feedback to reduce errors and improve processes and performance.

Primary Responsibilities:

  • Provide appeals support by reviewing, researching, investigating, and auditing Part C 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

Required Qualifications:

  • High School Diploma / GED or higher
  • 1+ years of experience analyzing and solving Medicare beneficiary and / or provider issues in an office setting environment
  • Appeals experience with Medicare and Retirement Part C plans
  • Experience in using Microsoft Outlook to manage emails and calendar invites
  • Fully proficient with all HIPPA guidelines
  • Flexible to work overtime as business needs require

Preferred Qualifications:

  • Experience in using Microsoft Excel to create and maintain spreadsheets
  • Experience in using Microsoft Word to create and maintain files

Soft Skills:

  • Ability to multi - task, and prioritize work assignments
  • Ability to understand multiple products and multiple levels of benefits within each product

Physical Requirements and Work Environment:

  • Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouse
  • Office environment
UnitedHealth Group is a team of more than 260,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life's best work.SM

Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in healthcare. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our Healthcare system. Ready? It's time to do your life’s best work.SM

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Job Details

  • Contest Number756243
  • Job TitleIRE Validation Analyst - Cypress, CA or Telecommute in CA only
  • Job FamilyClaims
  • Business SegmentUHC Benefit Ops - MandR Ops

Job Location Information

  • Cypress, CA
    United States
    North America
  • Other LocationsSan Diego, CA
    Los Angeles, CA
    Sacramento, CA
    Chico, CA
    Oakland, CA

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

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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