Claims Examiner - Hybrid

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