Job Description

Job Title: Technical Claims Specialist
Job ID: 86782627
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: TPA CCBH Metro ClaimsOps
Location: 600 Grant St, Pittsburgh PA 15219

Description


Resolves pended claims while meeting or exceeding the designated production and quality standards. Updates data and configuration within the MC400 system.

Responsibilities:
  • Working knowledge of McNet/Batch errors
  • Mentor new team members
  • Interact with internal and external customers to resolve claim adjudication/adjustment issues
  • Maintain mail date integrity
  • Maintain employee/insured confidentiality
  • Resolve outstanding items in accordance with designated standards
  • Successfully complete special projects within designated standards
  • 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
  • Worked department overtime as required per business need
  • 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
  • Assist with department or other department backlogs as needed
  • Assist with entry/adjudication of claim testing
  • Process standard to complex claims in accordance with company policy and procedures in a timely manner while meeting or exceeding production and quality goals
  • Participate in training programs

Qualifications

  • 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.

Licensure, Certifications, and Clearances:

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $17.62 to $29.28 / hour

Union Position: No

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