Description
Are you a health insurance professional with a strong background in dental and vision claims? If so, an opportunity as a Technical Claims Specialist II with UPMC Health Plan's Ancillary team may be the perfect fit for you.
In this position you will analyzes, and monitor reports, claims, and data to measure performance outcomes. You will assists in research for department projects and provides technical and plan support to management team/business analyst.
Responsibilities:
Responsibilities:
- Reviews, monitors, and researches claim data, issues, and/or reports
- Serves as a Claims Operations representative at internal and external meetings
- Working knowledge of McNet/Batch errors and resolution
- Performs in accordance with system-wide competencies/behaviors
- Participate in the development/refinement of policies and procedures
- Thorough understanding of standard to complex claims and adjustments
- Provides technical support and guidance to support the operations division's goals and objectives
- Provides quality customer service to internal and external customers
- Assist the department as requested during periods of backlogs
- Process/adjust most sensitive; high profile inventories such as high dollar claims; accumulator adjustments
- Complete special projects as assigned
- Understands client performance expectations and aligns assigned responsibilities accordingly
- Serves as a process expert
- Meets or exceeds established tasks timeframes/deadlines
- Participates/partners in Quality Audit/training meetings for process improvement opportunities
- Provide weekly trending/work summary reports to management/Business Analyst team
- Research and respond to both external and internal inquiries in a timely manner
Qualifications
- High school graduate or equivalent required.
- College degree preferred.
- Three years health insurance, claims processing and/or customer service experience preferred.
- Knowledge of medical terminology, ICD-9 and CPT coding required.
- Knowledge of commercial, Medicaid, and Medicare products preferred.
- Competency in MS Office with strong emphasis on Excel, Word, and Access. PC skills required.
- Ability to demonstrate organizational, interpersonal, and communication skills.
- Demonstrated analytical skills required.
- Ability to work independently with minimum direction.
- Ability to prioritize and perform multiple tasks to meet established deadlines. Extensive knowledge/experience with Coordination of Benefit determinations/investigation strongly preferred and a definite plus.
- Minimum of 2 years Coordination of benefits claim adjudication desired.
- Previous dental and/or vision experience highly preferred.
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.
