Claims Examiner (CHC/Medicaid)

UPMC • Pittsburgh, PA

8d • Hybrid

About The Position

We’re looking for detail-oriented problem solvers to join our CHC/Medicaid Claims team. 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.
Why this role matters:
As a Claims Examiner, you’ll play a key role in helping our members live healthier, more independent lives. By accurately processing claims, you ensure that people receive the care they need.

Requirements

• Strong attention to detail and ability to prioritize tasks.
• Comfort working in a fast-paced production environment.
• Previous health insurance experience
• Comfort working independently in a remote environment while staying connected with your team.
• A commitment to accuracy, teamwork, and client satisfaction.
• High school graduate or equivalent required.
• Knowledge of medical terminology, ICD-9, and CPT coding required.
• 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
• Knowledge of commercial, Medicaid, and Medicare products.
• Competent in MS Office and PC skills preferred.
• Working knowledge of COB (Coordination of Benefits) preferred.
• Ability to demonstrate organizational, interpersonal, and communication skills.
• Previous computer experience in a professional setting is highly preferred.

Responsibilities

• Review and process moderate to complex claims with precision and efficiency.
• Meet or exceed quality and production standards—your accuracy makes a difference!
• Collaborate with your team, share ideas, and help us continuously improve.
• Support other departments during busy periods and participate in training to grow your skills.
• Maintain confidentiality and uphold compliance standards.
• Work occasional overtime when business needs arise.

What This Job Offers

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