UPMC Health Plan has an exciting opportunity for a Claims Examiner in the Operations department. This is a hybrid full-time position working Monday through Friday daylight hours. The Claims Examiner will manage adjudication of standard to moderate 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
- 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