Job Description

Job Title: Team Leader, TPA Claims
Job ID: 692384
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: TPA Claims_Ops
Location: 600 Grant St, Pittsburgh PA 15219


Are you a health insurance professional with a strong claims background?  If so, an opportunity as a Team Leader with UPMC Health Plan's TPA Claims Operations team may be the perfect fit for you.  In this role, you will provide technical and plan support to claims examiners and adjustment/COB staff. Additionally, you will assist with development and training of team members while processing VIP claims and adjustments. Resolve customer concerns as needed. Assume supervisory responsibility as necessary.  This position will work a Monday through Friday schedule with evenings, weekends, and holidays as needed.

  • 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.


  • Bachelor's degree or equivalent education and experience.
  • Five years health insurance, medical claims processing, claim adjustment; coordination of benefits, and/or customer service experience required with a minimum three of those years Managed Care, Benefit Administration, PPO, HMO, Medicare, Medicaid, and Coordination of Benefits (COB); 
  • Third Party Liability claim adjudication/adjustments 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

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