Job Description

Job Title: Technical Claims Specialist- Web Message Provider
Job ID: 25162177
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: Provider Services
Location: 1650 Metropolitan Street, Pittsburgh PA 15233


Are you a health insurance claims professional with at least two years of claims processing experience?  If so, an opportunity as a Technical Claims Specialist with UPMC Health Plan may be the perfect fit for you.  This role resolves pended claims while meeting or exceeding the designated production and quality standards. Additionally, this role updates data and configuration within the MC400 system.  If this sounds like next step in your career, apply today!

  • 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


  • 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.
  • One year of Provider Service experience preferred.

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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