Job Description

Job Title: Technical Claims Specialist
Job ID: 662787
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Community HealthChoices
Location: 1650 Metropolitan Street, Pittsburgh PA 15233

Description

Purpose:
Are you a health insurance claims professional with at least two years of claims processing experience?  If so, an opportunity as a Technical Claims Specialist with UPMC Health Plan may be the perfect fit for you.  This role resolves pended claims while meeting or exceeding the designated production and quality standards. Additionally, this role updates data and configuration within the MC400 system.  If this sounds like next step in your career, apply today!

Responsibilities:
  • Assist with department or other department backlogs as needed
  • Assist with entry/adjudication of claim testing
  • Interact with internal and external customers to resolve claim adjudication/adjustment issues
  • Maintain employee/insured confidentiality
  • Maintain mail date integrity
  • Mentor new team members
  • Must be able to manage multiple priorities according to designated standards
  • Openly participate in team meetings and offer ideas and suggestions to ensure client satisfaction and promote teamwork
  • Participate in training programs
  • Process standard to complex adjustments (project reports, claim adjustment pends, corrected claims, CUT logs) according to designated standards, while meeting or exceeding production and quality goals
  • Process standard to complex claims in accordance with company policy and procedures in a timely manner while meeting or exceeding production and quality goals
  • Resolve outstanding items in accordance with designated standards
  • Successfully complete special projects within designated standards
  • Worked department overtime as required per business need
  • Working knowledge of McNet/Batch errors

Qualifications

  • High school diploma or equivalent. 
  • Two years claims processing experience required. 
  • Ability to use a QWERTY keyboard. 
  • Knowledge of medical terminology, ICD-9 and CPT coding required. 
  • Knowledge of commercial, Medicaid, and Medicare products preferred. 
  • Competency in Microsoft Office and PC skills preferred. 
  • Ability to demonstrate organizational, interpersonal, and communication skills.  
  • Ability to prioritize and perform multiple tasks while maintaining designated production and quality standards.
  • Strong knowledge and working ability with ICD-10.
  • Health insurance claims processing experience is highly preferred.

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

Salary Range: $17.11 to $28.43

Union Position: No

Apply Current Employee?

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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