At UPMC, we are committed to keeping our community safe and healthy as the COVID-19 pandemic unfolds. As our team continues to provide Life Changing Medicine to our patients, our recruiters will continue to fill positions throughout this time. Interviews and other processes may be modified to protect the safety of our candidates and employees. Thank you for your patience.

For more information about UPMC's response to COVID-19, please visit upmc.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Claims Examiner

Description

At UPMC, we're exceeding production and quality of designated standards for claims processing, and we want you to join our team! UPMC Health Plan is currently seeking full-time Claims Examiner positions at our two locations. These positions will be at the US Steel Tower and our Harbor Gardens Locations. As a key member of our team, you will manage adjudication of moderate to complex claims. Additionally, you will be responsible for processing moderate to complex claims, including COB (Coordination of Benefits), in accordance with company policies and procedures in a timely manner while meeting or exceeding production and quality standards. 

 

Responsibilities:

  • Resolve outstanding holds in accordance with designated standards. 
  • Maintain employee/insured confidentiality. Participate in training programs as requested. 
  • Identify areas of concern that may compromise client satisfaction. 
  • Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork. 
  • Maintain mail date integrity. 
  • Assist other departments during periods of backlogs. 
  • Effectively prioritize and complete all assigned tasks. 
  • Process MCNet batches by resolving various claim errors in accordance with designated standards. 
  • Overtime may be required as per business need.

Qualifications

 

Qualifications

  • High school graduate or equivalent required. 
  • One year of claims processing and/or equivalent education preferred. 
  • Knowledge of medical terminology, ICD-9, and CPT coding required. 
  • Knowledge of commercial, Medicaid, and Medicare products. 
  • Ability to use a QWERTY keyboard. 
  • Competent in MS Office and PC skills preferred. 
  • Working knowledge of COB (Coordination of Benefits) preferred. 
  • Ability to demonstrate organizational, interpersonal, and communication skills. 
  • Maintain designated production and quality standards required.

 

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

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