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   Current UPMC employees must apply in HR Direct

Claims Examiner

  • Job ID: 200000F9
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: TPA CCBH Claims_Ops
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: non uniln
  • Salary Range: $15.97 to $25.15 / hour

Description

UPMC Health Plan's Claims Department is seeking Claims Examiners to support their teams.

 

This role is responsible for managing the adjudication of moderate to complex claims while meeting or exceeding production and quality designated standards.

 

This is a full time role in the US Steel Tower. Apply today!


Responsibilities:

  • Assist other departments during periods of backlogs;
  • Effectively prioritize and complete all assigned tasks
  • Identify areas of concern that may compromise client satisfaction;
  • Maintain employee/insured confidentiality;
  • Maintain mail date integrity;
  • Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork;
  • Participate in training programs as available/requested;
  • Process MCNet/Batch Edit errors in accordance with designated standards;
  • Process standard to moderate claims, including COB, 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;
  • Work overtime as required per business need

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 org

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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