14 days old

Senior Claims Auditor - Irvine, CA

Irvine, CA 92606
  • Job Code
The Senior Claims Auditor is responsible for reviewing all processed claims prior to payment release, and respond to all potential health plan capitation deduction report for Health Maintenance Organization (HMO) Enrollees for Medicare and HMO Enrollees.

Primary Responsibilities:
  • Performs routine and moderately complex audits on paper and electronic claims for payment integrity in alignment with regulatory standards and timelines, business policy, contract, appropriate coding, and system configuration with ability to extract and audit exception audit reports
  • Researches claim processing problems and errors to determine their origin and appropriate resolution. Prepare reports and summarizes observations for management summarizing observations and recommendations
  • Participates in communication with Business Operations management regarding trends in order to improve claims processing accuracy and documented business rules for incorporation into training programs, policies and procedures
  • Identifies and escalates issues related to instructional material that is inaccurate, unclear or contains gaps. Provides recommendations for correction of this material. Confers with management to assess training needs in response to changes in policies, procedures, regulations, and technologies
  • Performs special project audits and reviews as requested by other departments/regions
  • Maintains a minimum audit accuracy rate
  • Complete other related duties as assigned
  • Regular and consistent attendance

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.



Posted: 2020-09-11 Expires: 2020-10-11

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Senior Claims Auditor - Irvine, CA

UnitedHealth Group
Irvine, CA 92606

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