Job DescriptionJob Title:
Team Leader, ClaimsJob ID:
UPMC Health PlanDepartment:
1650 Metropolitan Street, Pittsburgh PA 15233 DescriptionPurpose:
Provide technical and plan support to claims examiners and non-par provider specialist staff. Assist with development and training of team members. Process VIP claims and adjustments. Resolve customer concerns as needed. Assume supervisory responsibility as necessary.Responsibilities:
- Research and respond to both external and internal inquiries in a timely manner.
- Perform system demonstrations for prospective/existing clients.
- Process claims and/or adjustments.
- Complete special projects as assigned.
- Maintain employee and insured confidentiality.
- Assume supervisory responsibility in the absence of the supervisor.
- Identify and participate in the training needs of team members.
- Assist other departments as requested during periods of backlogs.
- Provide technical support to team members.
- Participate in the development/refinement of policies and procedures.
- Support cross-functional team members to meet or exceed quality and production designated standards.
- Assist with inventory control measures.
- Bachelor's degree or equivalent experience
- Minimum of five years of health insurance, medical claims processing, claim adjustment; coordination of benefits, and/or customer service experience required
- 3 years of experience in managed care, benefit administration, PPO, HMO, Medicare, Medicaid, and coordination of benefits, third-party liability claim adjudication/adjustments preferred
- Knowledge of Medical Terminology, ICD-10, and CPT coding required
- Competent in MS Office and PC skills
- Ability to demonstrate organizational, interpersonal, and communication skills
Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran
$20.71 to $34.54 / hourUnion Position:
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Posting ID: 555275161Posted: 2020-07-14