Job Description

Job Title: Senior Claims Examiner
Job ID: 707537
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: Operations
Location: 1650 Metropolitan Street, Pittsburgh PA 15233


UPMC Health Plan's Operations team is seeking a Senior Claims Examiner!


This person will manage adjudication of multiple claim types and adjustments while meeting or exceeding production and quality designated standards. Present efficient and courteous resolution to verbal and written inquiries to ensure customer satisfaction. Consistence maintenance of mail date.


The following is preferred: Healthcare Knowledge, Health Insurance background in Claims, AR or related fields.


  • Assist with department or other department backlogs as needed
  • 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 simple adjustments (project reports, claim adjustment pends, corrected claims) 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
  • Worked department overtime as required per business need
  • Working knowledge of McNet/Batch errors


  • High school graduate or equivalent.
  • One year claims processing or related experience required.
  • Proficiency in typing required.
  • Ability to maintain designated production and quality standards.
  • Excellent knowledge of medical terminology, ICD-9 and CPT-4 coding.
  • Excellent knowledge of HMO, PPO, and POS plans.
  • Excellent knowledge of coordination of benefits, subrogation, and Medicare.
  • MS Office/PC skills.
  • Excellent organizational skills, interpersonal and communication skills.
  • Detail oriented.

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

Salary Range: $15.13 to $23.82

Union Position: No

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