Claims Examiner -CHC

UPMC Health Plan has an exciting opportunity for a Claims Examiner position 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