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IRE Validation Analyst - Cypress, CA

UnitedHealth Group
Cypress, CA
View UnitedHealth Group Company Profile


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.

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 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


    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

      • Experience in using MS Word to create and maintain files

      • Experience in using MS Outlook to manage emails and calendar invites

      • Fully proficient with all HIPPA guidelines

      • Flexible to work overtime as business needs require

      • Appeals experience with Medicare and Retirement Part C plans


      • Experience in using MS Excel to create and maintain spreadsheets

      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

          Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.

          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.

          Keywords: UHG, Medicare Part C, healthcare, Cypress, UHC


          • JobId: 720752
          • Position Type: Full-Time
          • Experience Level: Not Specified
          • Posted / Updated: 7/17/2017