Job Description

Job Title: Technical Claims Specialist- TPA
Job ID: 754366
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 looking for a collaborative environment that will allow you to make the most of your health insurance claims experience?  If so, the Technical Claims Specialist role with UPMC Health Plan could be the perfect position for you!  In this role, you will work with our MLTSS and CHC team to resolve pended claims while meeting or exceeding the designated production and quality standards.  Additionally, you will update data and configuration within the MC400 system.  If this role sounds like a great fit for you, apply today!

  • 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


  • 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 MS 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.
  • Previous medicaid experience preferred. 

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

Salary Range: $17.11 to $28.43 / hour

Union Position: No

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