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   Current UPMC employees must apply in HR Direct

Technical Claims Specialist

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/Disability/Veteran

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