Job Description

Job Title: Team Leader, Claims
Job ID: 712326
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Community HealthChoices
Location: 600 Grant St, Pittsburgh PA 15219

Description

Provide technical and plan support to claims examiners and adjustment/COB staff. Assist with development and training of team members. Process VIP claims and adjustments. Resolve customer concerns as needed. Assume supervisory responsibility as necessary.

Responsibilities:
  • Assist other departments as requested during periods of backlogs.
  • Assist with inventory control measures.
  • Assume supervisory responsibility in the absence of the supervisor.
  • Complete special projects as assigned.
  • Identify and participate in the training needs of team members.
  • Maintain employee and insured confidentiality.
  • Participate in the development/refinement of policies and procedures.
  • Perform system demonstrations for prospective/existing clients.
  • Process claims and/or adjustments.
  • Provide technical support to team members.
  • Research and respond to both external and internal inquiries in a timely manner.
  • Support cross-functional team members to meet or exceed quality and production designated standards.

Qualifications

  • Bachelors degree or equivalent education and related work experience required.
  • Minimum of five years of health insurance, medical claims processing, claim adjustment; coordination of benefits, and/or customer service experience required.
  • Minimum of three years of experience in managed care, benefit administration, PPO, HMO, Medicare, Medicaid, and coordination of benefits,third-party liability claim adjudication/adjustments required.
  • Knowledge of Medical Terminology, ICD-10, and CPT coding required
  • Competent in MS Office and PC skills.
  • Ability to demonstrate organizational, interpersonal, and communication skills.

    Licensure, Certifications, and Clearances:
    UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $19.70 to $32.88

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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