Job Description

Job Title: Claims Examiner
Job ID: 190000TX
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: Operations
Location: 600 Grant St, Pittsburgh PA 15219


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. 



  • 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.




  • 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.


Salary Range: $14.97 to $23.54 / hour

Union Position: non union

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At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!


UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.


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