Job details
Job type full-time
Full job description
Description
Upmc health plan is hiring a full-time accumulator adjuster i to support the operations support departmentThis is a monday - friday, daylight positionThis is a hybrid role with remote/work-from-home privileges in pa and some travel into the office (pittsburgh, pa) for trainings, meetings, department needs, etc.
The accumulator adjuster i will resolve moderate to complex pended claims while meeting or exceeding the designated production and quality standardsThey will review and resolve simple to moderate accumulator discrepanciesThey will analyze and monitors reports, claims, and data to measure performance outcomes.
Responsibilities:
Process/adjust most sensitive; high profile inventories such as high dollar claims; accumulator adjustments.performs in accordance with system-wide competencies/behaviors.provides quality customer service to internal and external customers.
Participates/partners in quality audit/training meetings for process improvement opportunities.assist other departments as requested during periods of backlogs.understands client performance expectations and aligns assigned responsibilities accordingly.
Working knowledge of mcnet/batch errors and resolution.maintain employee and insured confidentiality.reviews, monitors, and researches claim data, issues, and/or reports.
Meets or exceeds established tasks timeframes/deadlines.provide weekly trending/work summary reports to management/business analyst team.participate in the development/refinement of policies and procedures.
Research and respond to both external and internal inquiries in a timely manner.assist with special projects as assigned.
Qualifications
High school graduate or equivalent required.
College degree preferred.
3 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 regarding medical accumulations/deductible/out-of-pocket is strongly preferred and a definite plus.
Licensure, certifications, and clearances:
Act 34
Upmc is an equal opportunity employer/disability/veteran
