Team Leader, Claims

    University of Pittsburgh Medical Center
    1650 Metropolitan Street, Pittsburgh, PA 15233
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    Job Description

    Job Description
    Job Title:Team Leader, Claims
    Job ID:34434846
    Shift:Day Job
    Facility:UPMC Health Plan
    Location:1650 Metropolitan Street, Pittsburgh PA 15233


    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.

    • 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
    Salary Range:$20.71 to $34.54 / hour

    Union Position:No

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    Posting ID: 555275161Posted: 2020-07-14