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Job Field: Environmental Jobs
Location: Irvine, CA
Salary: $Not stated

JOB SUMMARY:

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<tr><td valign="top" width="450"><b>Title: Medical Claims Review Specialist - Irvine, CALocation: US-CA-IrvineJob Number:_503972Position Description:<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />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 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.Positions in this function are responsible for all aspects of quality assurance within the Claims job family. Conducts audits and provides feedback to reduce errors and improve processes and performance.Primary Responsibilities:* Provide expertise claims support by reviewing, researching, investigating, auditing claims* Analyze and identify trends and provides feedback and reports to reduce errors and improve claims processes and performance* Responsible for all aspects of quality assuranceQualifications:Requirements:<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />* High School Diploma or GED required* 3 years of medical claims processing required* Knowledge of compliance and regulatory governing agencies (CMS, DMHC, and DHS)* 2 years of Provider Disputes, Appeals, or Appeals and Grievance experience required* ICD-9 and CPT coding experience and knowledge required* 2 years of Provider contract interpretation experience required* 2 years HMO claims experience required* Basic MS Word and Excel experience requiredOptumHealth is part of the family of companies that makeUnitedHealth Groupone of the leaders across most major segments of the US health care system.OptumHealth 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.At OptumHealth, you will perform within an innovative culture that''s focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that''s greater than you''ve ever imagined.Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth 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.Job: Claim Quality

KEY REQUIREMENTS:

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