Description

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

This position is fully remote. (privilege eligibility is subject to continued achievement of business goals and on-site department needs).

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:

• Act 34
• UPMC is an Equal Opportunity Employer/Disability/Veteran