Job Description

Job Title: Team Leader, Claims CHC
Job ID: 727834
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: CHC Claims Operation
Location: 600 Grant St, Pittsburgh PA 15219


Are you a dynamic leader with a strong background in health insurance claims? If so, the position of Team Lead, Claims may be the perfect fit for you.  In this role you will provide technical and plan support to claims examiners and adjustment/COB staff while assisting with development and training of the team members.  Additionally, this role is responsible for processing VIP claims and adjustments while resolving customer concerns as needed. If this sounds like the ideal next step in your career, apply toda

  • 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 3 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 Microsoft 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 / hour

Union Position: No

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