Claims Examiner -CHC

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 45,000 - 65,000; Full time

Job summary

UPMC Health Plan is seeking a Claims Examiner in the CHC Claims Operations team. This full-time hybrid role combines remote work with in-office presence in the Pittsburgh, PA area, focusing on adjudication of moderate to complex claims and adherence to production and quality standards.

You will participate in training, support backlogged workflows, and ensure confidentiality while handling COB and standard claims processes, aiming for timely resolutions and strong client satisfaction.

Responsibilities

• Participate in training programs as available.
• Assist other departments during backlogs.
• Join team meetings and share ideas to improve client satisfaction.
• Process MCNet/Batch Edit errors per standards.
• Maintain confidentiality of employees and insured data.
• Work overtime as needed.
• Identify areas that may affect client satisfaction.
• Maintain mail date integrity.
• Process standard to moderate claims, including COB, per policies.
• Resolve outstanding holds per standards.
• Prioritize and complete all assigned tasks.

Job description

UPMC Health Plan has an exciting opportunity for aClaims Examinerposition in the CHC Claims Operations department. This is a full-time hybrid position consisting of working from home and in office. Must be located in or around Pittsburgh, PA to be considered. The Claims Examiner will manage adjudication of moderate to complex claims while meeting or exceeding production and quality designated standards.

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;
• Maintain mail date integrity;
• 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