Hybrid Claims Examiner: Moderate-Complex Claims

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 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.