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Claims Examiner- CHC

  • Job ID: 040235298
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: CHC Claims Operation
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $15.42 to $24.25 / hour

Description

UPMC Health Plan's Claims Department is seeking a Claims Examiner to support its' Community Health Choices Venture.

 

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


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

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 organizational, interpersonal, and communication skills.
  • Maintain designated production and quality standards required.

Licensure, Certifications, and Clearances:

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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