What are the responsibilities and job description for the Claims Examiner position at UPMC?
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.
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.
Salary : $1,000 - $1,000,000