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UPMC continues to comply with governmental guidance related to local, state, and federal COVID-19 vaccination for employment. All employees and affiliated staff of UPMC entities are considered essential health care workers and will be accountable to follow the Centers for Medicare & Medicaid Services (CMS) federal vaccine mandate. To be compliant with the federal mandate, employees must complete the approved vaccination dosage regimen currently defined by the federal government. Compliance with the federal mandate is encouraged before hire and is required after employment begins. Medical and religious exemption requests may be submitted for consideration.

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

Supervisor, Claims- Direct Member Reimbursement (DMR)

Description

Are you a dynamic leader with a background in health insurance?  If so, UPMC may have the perfect employment fit for you!

UPMC Health Plan is hiring a full-time Supervisor, Claims (Direct Member Reimbursement, DMR) to support the Operations department. This is a Monday - Friday daylight role. This is a hybrid position, with remote/work-from-home privileges in PA and some travel to the office for trainings, meetings and department needs.

The Supervisor plays an integral role in leading a dynamic team of claims staff members. The Supervisor leads with our UPMC values top of mind and coaches team members to help them achieve their highest potential.

This role is responsible for training personnel, preparing and giving evaluations to employees, and maintaining excellent working relationships with all departments. Responsible for team performance, including accurate and timely completion of assigned claim inventories. The incumbent ensures effective employee development and training. The Supervisor must use their knowledge and understanding of claim inventory trends and other information generated to identify opportunities to improve claim performance.


Responsibilities:

  • Manage special projects
  • Work in conjunction with other Supervisors to allocate and adjust team resources as daily needs required
  • Identify trends and partner with the Support team and Management to make recommendations and improve operational performance
  • Participate in interviewing, hiring, and training of team members
  • Enhance communication via effective team meetings, huddles, and employee one on ones
  • Ensure team performance meets or exceeds claim timeliness and quality standards for regulatory compliance and performance guarantees
  • Meet deadlines and turnaround times set by management (these deadlines and turnaround times will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended work weeks, or both)
  • Maintain a positive work environment through employee recognition and interaction
  • Strategize, plan, organize, and execute efficient inventory management
  • Supervise and monitor the ongoing performance of team members. Continually examine team performance against department standards. This includes timely employee feedback via employee scorecards

Qualifications

  • Bachelor's degree in business, health care or management related field or equivalent experience;
  • Minimum 3 years of health insurance experience preferred;
  • Minimum 3 years leadership experience (leading, mentoring, coaching, or teaching);
  • Excellent planning, communication, documentation, organization, analytical and problem-solving abilities; Medical Terminology or medical billing experience;
  • High level of professionalism, enthusiasm, and initiative on a daily basis;
  • Working knowledge of Commercial, Medicaid and Medicare plans;
  • Working knowledge regarding Coordination of Benefits;
  • Ability to maintain quality and production designated standards established for handling work, problem solve effectively and organize workflow;
  • Ability to handle multiple priorities in a fast-paced production environment;
  • Some travel may be required.
  • Must be able to serve as a positive extension of the management team.



Licensure, Certifications, and Clearances:

  • Act 34

  • 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 — 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.

   Current UPMC employees must apply in HR Direct