Claims Examiner

UPMC • Pittsburgh, PA

2h

About The Position

UPMC Health Plan has an exciting opportunity for a Claims Examiner in the Operations department. This is a 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.

Requirements

• High school graduate or equivalent
• Knowledge of medical terminology, ICD-9, and CPT coding
• Ability to use a QWERTY keyboard
• Ability to demonstrate organizational, interpersonal, and communication skills
• Maintain designated production and quality standards

Nice To Haves

• One year of claims processing and/or equivalent education
• Knowledge of commercial, Medicaid, and Medicare products
• Competent in MS Office and PC skills
• Working knowledge of COB (Coordination of Benefits)

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.
• 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.
• Claim entry including batch rekeys.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees