COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Sr. Claims Manager

  • Job ID: 537249528
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: TPA CCBH Claims_Ops
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $37.20 to $62.96 / hour

Description


Are you a leader who desires to make a real difference? Are you ready to lead a consistently high-performing team to greater outcomes? Then this may be the role for you! The senior claims manager reports to the Director of Operations and assumes responsibility for directing all activities related to claims administration. This position is responsible for providing leadership and direction to supervisory and manager-level staff to meet or exceed UPMC Health Plan business objectives.

This position will be 90% remote. Travel to the office will be needed for occasional meetings, training, etc. (privilege eligibility is subject to continued achievement of business goals and on-site department needs).

 

The Team

We are a top Healthcare Claim Operations team delivering performance excellence. We take pride in the timely and accurate end-to-end claim adjudication and adjustments for services rendered in a fast-paced, supportive, and innovative work environment.


Responsibilities:

 

  • Manage claims operating budget in excess of ($5,000,000).
  • Maintains compliance accountability specific to claims administrations in accordance with applicable state and federal laws (s);
  • Provide leadership and direction through developing and updating procedures, programs, determining appropriate standards and procedures, determining staffing requirements, and training opportunities.
  • Lead work groups that encompass system users, claims processors, and other to identify problems and propose systematic solutions, and develop/maintain necessary work plans.
  • Recruit and discharge employees when necessary.
  • Provide central coordination and control for implementation of new/changed application and systems.
  • Analyze and trend claims related data to identify inefficiencies and implement process improvement;
  • Manages and directs staff, supporting professional growth by providing education, training and appropriate resources.
  • Serve as liaison to clients with participation in demonstration of operations activities to prospective clients as well as maintenance of communication with established clients.
  • Maintain a positive work environment for direct management reporting staff, ranging from 5-7, with line staff of up to 200.
  • Must have the ability to effectively interact with internal and external customers.
  • Manage and direct all activities and special projects.
  • Maintain designated standards established for handling incoming work.

 

Qualifications

  • Bachelor's Degree preferred or equivalent business experience of five (5) years.
  • Five years minimum management experience required
  • Project Management experience is highly preferred
  • Strong leadership and staff development skills are highly preferred
  • Experience in multi-million dollar budget preparation preferred
  • Expert knowledge of medical terminology, ICD coding and CPT coding required
  • Incumbents must have strengths in methods and techniques of business process automation
  • Proficient knowledge in MS Office and PC skills preferred;
  • Able to demonstrate excellent organizational, interpersonal, and communication skills
  • Maintain designated production and quality standards required
  • Ability to react to users' needs in a timely and efficient manner and direct staff with a minimal amount of supervision


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

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