COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

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. 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

Claims Examiner- Remote

  • Job ID: 676871686
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: TPA CCBH Claims_Ops
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $16.36 to $25.72 / hour

Description


UPMC Health Plan is hiring full-time Claims Examiners for our TAP/CCBH departments. In this position you wil manage adjudication of moderate to complex claims while meeting or exceeding production and quality designated standards.

This position is fully remote (work from home).

 

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 is 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:

  • Act 34

  • 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