Claims Associate - Irvine, CA

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.Prescription Solutions helps consumers obtain the medications and products they need to live healthier lives. Services offered by the company include pharmacy network contracting, rebate contracting and administration, mail order pharmacy facilities, specialty drugs and retail drug claims processing.  The company is one of only three in the United States to have received URAC dual accreditation and provides clinical services to help its clients provide cost effective, quality-driven results.  The company is part of Pharmacy Services group, within Enterprise Services, a family of UnitedHealth Group businesses dedicated to improving the health and well-being of Americans.   Primary Responsibilities: Accurate processing and completion of medical claims upon first receipt. Process somewhat complex claims within current turnaround standards. Process same day voids and reconsideration. Proficiency in product lines applicable to site office. Understand medical plan concepts handled within the product lines. Access contracted rates, network information and special processing instructions. Process claims which include: Network requiring authorization, re-pricing, and/or use of self refer tables. Claims requiring MCR/Utilization Review. COB/Medicare. Claims requiring application of plan specific Special Processing Instructions (SPIs).  Access systems to obtain information that will assist in claims resolution. Special projects as required. Adhere to quality improvement initiatives. Use pre-approved electronic letters to communicate with customers.Qualifications: High school diploma or equivalent is required. 1 year of claims payment system experience is required. 1 year of claims processing experience is required; preferably in the medical field. 2 years of PC knowledge (MS Word and Excel) is required. ICD 9/CPT coding experience is preferred. 1 year of data entry experience is preferred. 10 key experience is preferred. Medical terminology is strongly preferred. Attention to detail. Quality focused. Strong written and verbal communication skills. Decision making skills. Organizational skills. Team player. Problem solving. Diversity creates a healthier atmosphere:  equal opportunity employer M/F/D/V.