Job Description

Job Title: Claims Examiner
Job ID: 200000F9
Status: Full-Time
Regular/Temporary: Regular
Shift: Day Job
Facility: UPMC Health Plan
Department: TPA CCBH Claims_Ops
Location: 600 Grant St, Pittsburgh PA 15219


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!


  • 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


  • 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

Salary Range: $15.97 to $25.15 / hour

Union Position: non uniln

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