"Alerted.org

Purpose:

Provide technical and plan support to claims examiners and adjustment/COB staff. Assist with development and training of team members. Process VIP claims and adjustments. Resolve customer concerns as needed. Assume supervisory responsibility as necessary.

This position will work a hybrid work structure reporting into the office as needed.

Responsibilities:

+ Research and respond to both external and internal inquiries in a timely manner.

+ Perform system demonstrations for prospective/existing clients.

+ Process claims and/or adjustments.

+ Complete special projects as assigned.

+ Maintain employee and insured confidentiality.

+ Assume supervisory responsibility in the absence of the supervisor.

+ Identify and participate in the training needs of team members.

+ Assist other departments as requested during periods of backlogs.

+ Provide technical support to team members.

+ Participate in the development/refinement of policies and procedures.

+ Support cross-functional team members to meet or exceed quality and production designated standards.

+ Assist with inventory control measures.

+ Bachelor's degree or equivalent experience.

+ Minimum of five years of health insurance, medical claims processing, claim adjustment; coordination of benefits, and/or customer service experience required; 3 years of experience in managed care, benefit administration, PPO, HMO, Medicare, Medicaid, and coordination of benefits, third-party liability claim adjudication/adjustments preferred

+ Knowledge of Medical Terminology, ICD-10, and CPT coding required

+ Competent in MS Office and PC skills.

+ Ability to demonstrate organizational, interpersonal, and communication skills. **Licensure, Certifications, and Clearances:** **UPMC is an Equal Opportunity Employer/Disability/Veteran**