At UPMC, we are committed to keeping our community safe and healthy as the COVID-19 pandemic unfolds. As our team continues to provide Life Changing Medicine to our patients, our recruiters will continue to fill positions throughout this time. Interviews and other processes may be modified to protect the safety of our candidates and employees. Thank you for your patience.

For more information about UPMC's response to COVID-19, please visit upmc.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Claims Examiner- CHC Part-Time

Description


At UPMC, we're exceeding production and quality of designated standards for claims processing, and we want you to join our team! UPMC Health Plan is currently seeking PART- TIME Claims Examiners for our CHC team.  As a key member of our team, you will manage adjudication of moderate to complex claims. Additionally, you will be responsible for processing moderate to complex claims, including COB (Coordination of Benefits), in accordance with company policies and procedures in a timely manner while meeting or exceeding production and quality standards. 

Although part-time, this position will require full-time hours during a six week training followed by a 12 week mentor lab/training curve. 


Due to COVID-19 circumstances, this position will temporarily work remotely. This role is eligible for long-term partial work from home privileges, after successful completion of orientation and training (privilege eligibility is subject to continued achievement of business goals and on-site department needs).

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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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

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