Senior Claims Business Process Analyst - Irvine, CA

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.SM 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 they 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. Senior Claims Business Process Analysts are responsible for all related aspects of claim system processes and claim business rules. Include claims systems utilization, capacity analyses/planning and reporting, claims-related business and systems analysis. Ensure data integrity, data security and process optimization.Positions in this function are responsible for all related aspects of claim system processes and claim business rules. Includes claims systems utilization, capacity analyses/planning and reporting. Includes claims-related business and systems analysis. Ensures data integrity, data security and process optimization.Primary Responsibilities:Responsible for providing research and root cause analysis for claim quality remediationPerform capacity planning and reporting Responsible for all aspects of quality assurance Create and edit requirements, specifications, cost benefit analysis and recommendations to proposed solutions Facilitate development of process documentation Follow standard programming guidelines and requirements as set by teamStandard documentation and tracking processes Uses pertinent data and facts to identify and solve a range of problems within area of expertise Develop and maintain documentation of department policies and procedures, client implementation documentation and compliance information as required. Understanding and awareness of Med D compliance, government regulations and policies and procedures for all new and legacy client business in order to ensure the team is compliant in their daily process. Maintain ongoing relationship with Med D and Compliance departments to ensure the teams/department have the most relevant and updated knowledge of regulations and our audit programs are prepared to address compliance results. Participate on cross functional teams related to government and regulatory review.Analyzes and investigates.Provides explanations and interpretations within area of expertise.

Requirements:HS Diploma/GED 2+ years of experience analyzing and solving customer
problems in an office setting environment3 + years in a
technical or metrics based environment Assets: Associate's Degree3+ years of Pharmacy Benefits ExperienceKnowledge of Medicare Part D compliance and regulationsRx Claims Processing ExperienceSoft Skills: Excellent Analytical Skill Strong written and verbal communication skillsAbility to work independently Ability to multi-task, this includes ability to
understand multiple products and multiple levels of benefits within each
productTake the next step, online at: www.yourlifesbestwork.comUnitedHealth Group is working to create the health care system of tomorrow. Already Fortune 14, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.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.