COVID-19 Vaccination Information
Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.
UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.
If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.
Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.
For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.
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- Job ID: 264844850
- Status: Full-Time
- Regular/Temporary: Regular
- Hours:
- Shift: Day Job
- Facility:
UPMC Health Plan
- Department: CHC Claims Operation
- Location:
1650 Metropolitan Street, Pittsburgh PA 15233
- Union Position: No
- Salary Range: $16.85 to $26.49 / hour
Description
UPMC Health Plan is hiring full-time Claims Examiners for our CHC department. In this position, you will
manage adjudication of moderate to complex claims while meeting or exceeding production and quality designated standards.
Our objective is to try to give members a better quality of life and studies have shown that people generally do better if they’re able to stay in their homes and communities.
This position is fully remote. (privilege eligibility is subject to continued achievement of business goals and on-site department needs).
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
Qualifications
- 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.
- Previous computer experience in a professional setting is highly preferred.
Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran
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At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.
Current UPMC employees must apply in HR Direct
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