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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.
- 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
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