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   Current UPMC employees must apply in HR Direct

Team Leader, Claims- Direct Member Reimbursement


UPMC Health Plan is looking to hire a full time Team Leader Claims for their Direct Member Reimbursement team. This position provides technical and plan support to claims examiners and adjustment/COB staff.  They will assist with development and training of team members.  In addition you will be responsible for processing VIP claims and adjustments and be in charge of resolving customer concerns as needed. Assume supervisory responsibility as necessary.

  • 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.


  • 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 required.
  • Competent in MS Office and PC skills.
  • Ability to demonstrate organizational, interpersonal, and communication skills.

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UPMC is an Equal Opportunity Employer/Disability/Veteran

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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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