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Claims Business Process Analyst - Irvine, CA - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Irvine, CA Irvine, California |
About this job
Position Description:
Energize your career with one of health care's fastest growing companies.
You
dream of a great career with a great company – where you can make an
impact and help people. We dream of giving you the opportunity to do
just this. And with the incredible growth of our business, it's a dream
that definitely can come true. Already one of the world's leading
health care companies, UnitedHealth Group is restlessly pursuing new
ways to operate our service centers, improve our service levels and help
people lead healthier lives. We live for the opportunity to make a
difference and right now, we are living it up.
This opportunity
is with one of our most exciting business areas: Optum –a growing part
of our family of companies that make UnitedHealth Group a Fortune 17
leader.
Optum helps nearly 60 million Americans live their lives
to the fullest by educating them about their symptoms, conditions and
treatments; helping them to navigate the system, finance their health
care needs and stay on track with their health goals. No other business
touches so many lives in such a positive way. And we do it all with
every action focused on our shared values of Integrity, Compassion,
Relationships, Innovation & Performance
Our claims
operations, including our Claims Business Process Analysts, 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 fast
paced challenge. It's a job that calls on you to be thoughtful,
resourceful, team-driven and customer-focused. To put it mildly, there
is never a dull moment.
Primary Responsibilities:
Energize your career with one of health care's fastest growing companies.
You
dream of a great career with a great company – where you can make an
impact and help people. We dream of giving you the opportunity to do
just this. And with the incredible growth of our business, it's a dream
that definitely can come true. Already one of the world's leading
health care companies, UnitedHealth Group is restlessly pursuing new
ways to operate our service centers, improve our service levels and help
people lead healthier lives. We live for the opportunity to make a
difference and right now, we are living it up.
This opportunity
is with one of our most exciting business areas: Optum –a growing part
of our family of companies that make UnitedHealth Group a Fortune 17
leader.
Optum helps nearly 60 million Americans live their lives
to the fullest by educating them about their symptoms, conditions and
treatments; helping them to navigate the system, finance their health
care needs and stay on track with their health goals. No other business
touches so many lives in such a positive way. And we do it all with
every action focused on our shared values of Integrity, Compassion,
Relationships, Innovation & Performance
Our claims
operations, including our Claims Business Process Analysts, 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 fast
paced challenge. It's a job that calls on you to be thoughtful,
resourceful, team-driven and customer-focused. To put it mildly, there
is never a dull moment.
Primary Responsibilities:
- Process Transitional Benefits claims in accordance with established policy and procedures
- Reprocessing Medicare Part D claims
- Reviewing Data Outcome
- Resolving claim adjudication rejections from the reprocess claims
- Contacting Pharmacy's for reversing and processing claims
- Keying data entry corrections
- Conducting basic research to clarify information
- Performing software enhancement testing
- Collaborating with other department to resolve data issues
- Maintaining claim system configurations
- Provide
expertise or general claims support by reviewing, researching,
investigating, negotiating, processing and adjusting claims - Analyze and identify trends and provides reports as necessary
- Consistently meet established productivity, schedule adherence, and quality standards
- Research and document all inquiries and complaints completely and thoroughly.
- Perform any other job related instructions as requested, with reasonable accommodation.
- Work is frequently completed without established procedures.
- Works independently.
- May act as a resource for others.
Requirements
- An
education level of at least a high school diploma or GED - Intermediate experience in Excel
- Basic experience in Word
- Ability to understand Part D Benefit, TrOOP/DS (True Out Of Pocket / Drug Spend), and multiple levels of benefits.
- Associates Degree or higher
- Microsoft SQL experience
- IBM iSeries Query experience
- Pharmacy Technician certification
- Experience in the healthcare field
- 2+ years' experience processing pharmacy claims
- 2+ years' experiences in a Medicare/CMS or related industry
- Experience with Medicare Part D and Prescription Drug Event calculations
- Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
OptumRx is
an empowering place for people with the flexibility to help create change.
Innovation is part of the job description. And passion for improving the lives
of our customers is a motivating factor in everything we do.
If you're ready to talk about groundbreaking
interactions, let's talk about what happens when a firm that touches millions
of lives decides to gather results from millions of prescriptions every month
and analyze their impact. Let's talk about smart, motivated teams. Let's talk
about more effective and affordable healthcare solutions. This is caring. This
is great chemistry. This is the way to make a difference. We're doing all this,
and more, through a greater dedication to our shared values of integrity,
compassion, relationships, innovation and performance. Join us and start doing your life's best work.
Diversity
creates a healthier atmosphere: All qualified applicants will receive
consideration for employment without regard to race, color, religion,
sex, national origin, protected veteran status, or disability status.
UnitedHealth Group
is a drug-free workplace. Candidates are required to pass a drug test
before beginning employment. In addition, employees in certain positions
are subject to random drug testing.
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