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 complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

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

DMR Claims Service Specialist I

Description


The DMR Claims Service Specialist I is responsible for the resolution of Health Plan Subscriber submitted claims while meeting or exceeding the designated production and quality standards. The DMR Claims/Service Specialist I validates the information on all medical claims submitted by UPMC Health Plan members seeking out of network reimbursement. Responsibilities include thoroughly reviewing claims to ensure there is no missing or incomplete information, manually entering claims into the claims processing system and complete outreaches to members or providers requesting all missing documentation. In addition, the DMR Claims/Service Specialist I must provide exceptional customer service while responding to inbound or outbound member calls regarding interpretation and education on claims processing outcome.

Responsibilities:

 

  • Remain current on all departmental policies, procedures, plan benefit designs, and modifications
  • Conduct outbound calls to request missing documentation, clarify follow up and resolve inquiries from customers regarding Direct Member Reimbursement claims. Investigate, document, and bring to resolution, all customer inquiries in accordance with Health Plan Subscriber Submitted Claims guidelines.
  • Maintain and update FileNet correspondence for all Direct Member Reimbursement claim types.Answer incoming inquiries from UPMC Health Plan members regarding Direct Member Reimbursement Claims.
  • Maintain employee and insured confidentialityParticipate in training programs as available/requested;
  • Process moderate to complex Direct Member Reimbursement claims, including Foreign, Cruise Ship, Lamaze, Flu Shot, Gym Membership and Pay to Provider Out of Network Claims, in accordance with company policies and procedures in a timely manner while meeting or exceeding production and quality standards.Accurately and efficiently manually keys OCR Rejection claim data into the MC400 system.
  • Document inquiries in accordance with UPMC Customer Service Center guideline.Submit Subscriber Acknowledgement and Delay letters according to claims timeliness guidelines
  • Review correspondence submitted by members and providers and process all related claims if the additional documentation submitted warrants processing/adjustments.Actively maintain worklist open cutlogs and follow up within the designated time standards.
  • Escalate issues and concerns in a timely fashion.Actively participate in departmental meetings, offer suggestions and resolutions related to current issues.

 

Qualifications

  • High school diploma or equivalent required
  • Bachelor's degree preferred;
  • Minimum of 2 years' health insurance; claims processing and/or customer service experience preferred;
  • Able to use a QWERTY keyboard
  • Knowledge of Insurance, Managed Care, or Benefits Administration environment preferred;
  • Knowledgeable in medical terminology, ICD-10 and CPT coding required;
  • Competent in MS Office with strong emphasis on Excel, Word, and Access. PC skills required;
  • Knowledge of Commercial, Medicaid, and Medicare products preferred;Skills:
  • Strong interpersonal skills with good verbal and written communication to internal and external clients.
  • This will incorporate call handling skills when required. Must possess excellent attention to detail, with a high level of accuracy. Maintain designated production and quality standards required.
  • Ability to prioritize and perform multiple tasks to meet established deadlines.
  • Confident in making decisions and exercising judgment where necessary. Strong customer focus with the ability to identify and solve problems.Must be flexible with responsibilities and have an exceptional ability to multitask.
  • Ability to work independently.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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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