Technical Claims Specialist II

Purpose: Analyzes, and monitors reports, claims, and data to measure performance outcomes. Assists in research for department projects. Provides technical and plan support to management team/business analyst. Responsibilities: + Reviews, monitors, and researches claim data, issues, and/or reports + Serves as a Claims Operations representative at internal and external meetings + Working knowledge of McNet/Batch errors and resolution + Performs in accordance with system-wide competencies/behaviors + Participate in the development/refinement of policies and procedures + Thorough understanding of standard to complex claims and adjustments + Provides technical support and guidance to support the operations division's goals and objectives + Provides quality customer service to internal and external customers + Assist the department as requested during periods of backlogs + Process/adjust most sensitive; high profile inventories such as high dollar claims; accumulator adjustments + Complete special projects as assigned + Understands client performance expectations and aligns assigned responsibilities accordingly + Serves as a process expert + Meets or exceeds established tasks timeframes/deadlines + Participates/partners in Quality Audit/training meetings for process improvement opportunities + Provide weekly trending/work summary reports to management/Business Analyst team + Research and respond to both external and internal inquiries in a timely manner + High school graduate or equivalent required. College degree preferred. + 3-5 years health insurance, claims processing and/or customer service experience preferred. + Knowledge of medical terminology, ICD-9 and CPT coding required. + Knowledge of commercial, Medicaid, and Medicare products preferred. + Competency in MS Office with strong emphasis on Excel, Word, and Access. + PC skills required. + Ability to demonstrate organizational, interpersonal, and communication skills. + Demonstrated analytical skills required. + Ability to work independently with minimum direction. + Ability to prioritize and perform multiple tasks to meet established deadlines. + Extensive knowledge/experience with Coordination of Benefit determinations/investigation strongly preferred and a definite plus. + Minimum of 2 years Coordination of benefits claim adjudication desired.Licensure, Certifications, and Clearances:UPMC is an Equal Opportunity Employer/Disability/Veteran