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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.

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Team Leader, Claims Adjustments

  • Job ID: 388157794
  • 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: $20.97 to $34.97 / hour

Description

UPMC Health Plan is hiring a full-time Team Leader to support the Claims Operations department. This is a Monday - Friday, daylight role (the shift start time is between 6:00 am and 7:00 am). This is a hybrid role, with some remote/work-from-home privileges, as well as some travel to the office for meetings, trainings, department needs, etc.

The Team Leader will provide technical and plan support to claims examiners and adjustment/COB staff. They will assist with development and training of team members, process VIP claims and adjustments, resolve customer concerns as needed and assume supervisory responsibility as necessary.

Experience with mentoring/coaching staff is preferred. A background working with claim adjustments is also highly preferred.


Responsibilities:

  • Research and respond to both external and internal inquiries in a timely manner.
  • Perform system demonstrations for prospective/existing clients.
  • Process claims and/or adjustments.
  • Complete special projects as assigned.
  • Maintain employee and insured confidentiality.
  • Assume supervisory responsibility in the absence of the supervisor.
  • Identify and participate in the training needs of team members.
  • Assist other departments as requested during periods of backlogs.
  • Provide technical support to team members.
  • Participate in the development/refinement of policies and procedures.
  • Support cross-functional team members to meet or exceed quality and production designated standards.
  • Assist with inventory control measures.

Qualifications

  • Bachelor's degree or equivalent experience.
  • Minimum of five years of health insurance, medical claims processing, claim adjustment; coordination of benefits, and/or customer service experience required;
  • 3 years of experience in managed care, benefit administration, PPO, HMO, Medicare, Medicaid, and coordination of benefits, third-party liability claim adjudication/adjustments preferred.
  • Knowledge of Medical Terminology, ICD-10, and CPT coding required
  • Competent in MS Office and PC skills.
  • Ability to demonstrate organizational, interpersonal, and communication skills.


Licensure, Certifications, and Clearances:



UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct