Job Description

Job Title: Team Leader, Claims- CHC
Job ID: 89061816
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: CHC Claims Operation
Location: 600 Grant St, Pittsburgh PA 15219

Description


Provide technical and plan support to claims examiners and adjustment/COB staff. Assist with development and training of team members. Process VIP claims and adjustments. Resolve customer concerns as needed. Assume supervisory responsibility as necessary.

Responsibilities:
  • Research and respond to both external and internal inquiries in a timely manner.
  • Perform system demonstrations for prospective/existing clients.
  • Process claims and/or adjustments.
  • Complete special projects as assigned.
  • Maintain employee and insured confidentiality.
  • Assume supervisory responsibility in the absence of the supervisor.
  • Identify and participate in the training needs of team members.
  • Assist other departments as requested during periods of backlogs.
  • Provide technical support to team members.
  • Participate in the development/refinement of policies and procedures.
  • Support cross-functional team members to meet or exceed quality and production designated standards.
  • Assist with inventory control measures.

Qualifications

  • Bachelor's degree or equivalent experience
  • Minimum of five years of health insurance, medical claims processing, claim adjustment; coordination of benefits, and/or customer service experience required; 3 years of experience in managed care, benefit administration, PPO, HMO, Medicare, Medicaid, and coordination of benefits, third-party liability claim adjudication/adjustments preferred
  • Knowledge of Medical Terminology, ICD-10, and CPT coding requiredCompetent in MS Office and PC skills.
  • Ability to demonstrate organizational, interpersonal, and communication skills.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $20.30 to $33.86 / hour

Union Position: No

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