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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 (Erie, PA)

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 hiring a team of full-time Claims Examiners to support the Operations department. This is a Monday – Friday daylight role and is based out of Erie, PA. This is a hybrid role, with some remote/work-from-home privileges, as well as some travel to the office for trainings, meetings, department needs, etc.

The Claims Examiners will manage 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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   Current UPMC employees must apply in HR Direct