UPMC Claims Examiner- Temporary in Pittsburgh, Pennsylvania
At UPMC, we're exceeding production and quality of designated standards for claims processing, and we want you to join our team! UPMC Health Plan is currently seeking full-time Claims Examiners. As a key member of our team, you will manage adjudication of moderate to complex claims. Additionally, you will be responsible for processing moderate to complex claims, including COB (Coordination of Benefits), in accordance with company policies and procedures in a timely manner while meeting or exceeding production and quality standards.
Assist other departments during periods of backlogs;
Effectively prioritize and complete all assigned tasks
Identify areas of concern that may compromise client satisfaction;
Maintain employee/insured confidentiality;
Maintain mail date integrity;
Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork;
Participate in training programs as available/requested;
Process MCNet/Batch Edit errors in accordance with designated standards;
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;
Work overtime as required per business need
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 Criminal Clearance or Act 34 Criminal Clearance with Renewa
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities REQNUMBER: 672896