Job Description

Job Title: Senior Claims Examiner
Job ID: 56518054
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: TPA CCBH Metro ClaimsOps
Location: 600 Grant St, Pittsburgh PA 15219


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.

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


  • 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: $15.58 to $24.54 / hour

Union Position: No

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