Claims Examiner - TPA/CCBH

UPMC•Pittsburgh, PA

1d•Hybrid

About The Position

UPMC Health Plan has an exciting opportunity for a Claims Examiner position in the TPA CCBH Claims Operations department. This is a full-time hybrid position based in the Pittsburgh area. While you’ll primarily work remotely, you’ll come into the office occasionally depending on departmental needs. The Claims Examiner will manage adjudication of moderate to complex claims while meeting or exceeding production and quality designated standards.

Requirements

High school graduate or equivalent required.
Knowledge of medical terminology, ICD-9, and CPT coding required.
Knowledge of commercial, Medicaid, and Medicare products.
Ability to use a QWERTY keyboard.
Maintain designated production and quality standards required.
Act 34

Nice To Haves

One year of claims processing and/or equivalent education preferred
Competent in MS Office and PC skills preferred.
Working knowledge of COB (Coordination of Benefits) preferred.
Ability to demonstrate organizational, interpersonal, and communication skills.

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 OASNet/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