• Claims Examiner- Medicare

    UPMC (Pittsburgh, PA)


    Purpose:

    UPMC Health Plan is seeking a full-time Claims Examiner to support the Medicare & Commercial Claims teams within the Claims Operations Department!

     

    The Claims Examiner will work daylight shifts between the hours of 6 a.m. and 4:30 p.m., Monday through Friday. No mandatory evenings or weekends are required! This role is fully remote, with the exception of occasional required in-office days for trainings, meetings, and other departmental needs.

     

    The Claims Examiner manages the adjudication of moderate-to-complex claims while meeting or exceeding production and quality designated standards. The Medicare and Commercial Claims teams have an established remote work culture and numerous opportunities for professional growth!

    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.

    + 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.

    + 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**