Job Description

Job Title: Technical Claims Specialist
Job ID: 65566570
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Operations
Location: 1650 Metropolitan Street, Pittsburgh PA 15233

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

Salary Range: $17.97 to $29.87 / hour

Union Position: No

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