Claims Examiner

UPMC • Pittsburgh, PA

1d • Hybrid

About The Position

UPMC Health Plan is hiring a full-time Claims Examiner to support our Claims Operations Department. As a Claims Examiner, you'll play a key role in reviewing provider-submitted claims to determine eligibility for payment or denial—ensuring accuracy, timeliness, and compliance with UPMC's standards. Your work helps ensure our members receive the care they need and our providers are supported with efficient, reliable claims processing. This is a hybrid position, with in-office presence required based on business needs such as trainings, team meetings, and departmental collaboration.

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.

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

• Process standard-to-moderate claims, including coordination of benefits (COB), in accordance with company policies and procedures.
• Resolve outstanding holds and ensure claims are completed within designated timelines.
• Support other departments during peak periods or backlogs.
• Participate in team meetings and training programs, sharing ideas and promoting teamwork.
• Maintain confidentiality of member and employee information.
• Identify and escalate issues that may impact client satisfaction.
• Work overtime as needed based on business demand.
• Stay organized and proactive, prioritizing tasks and maintaining productivity and quality standards.

Benefits

• Daylight Schedule: Work Monday through Friday between 6:00 AM and 4:30 PM—no mandatory evenings or weekends!
• Collaborative Environment: Be part of a supportive team that values your input and ideas.
• Mission-Driven Work: Your attention to detail helps ensure our members and providers receive the service they deserve.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED