Description
Provide technical and plan support to claims examiners and adjustment/COB staff. Assist with developing and training team members. Process VIP claims and adjustments. Resolve customer concerns as needed. Assume supervisory responsibility as necessary.
Responsibilities:
- Research and respond to both external and internal inquiries in a timely manner.
- Perform system demonstrations for prospective/existing clients.
- Process claims and/or adjustments.
- Complete special projects as assigned.
- Maintain employee and insured confidentiality.
- Assume supervisory responsibility in the absence of the supervisor.
- Identify and participate in the training needs of team members.
- Assist other departments as requested during periods of backlogs.
- Provide technical support to team members.
- Participate in the development/refinement of policies and procedures.
- Support cross-functional team members to meet or exceed quality and production designated standards.
- Assist with inventory control measures.
Qualifications
- Bachelor's degree or equivalent experience
- Minimum of five years of health insurance, medical claims processing, claim adjustment; coordination of benefits, and/or customer service experience required;
- 3 years of experience in managed care, benefit administration, PPO, HMO, Medicare, Medicaid, and coordination of benefits, third-party liability claim adjudication/adjustments preferred
- 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/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.