Claims Examiner (CHC/Medicaid)

We're looking for detail-oriented problem solvers to join our CHC/Medicaid Claims team. This is a full-time hybrid position based in the Pittsburgh area. While you'll primarily work remotely, you'll come into the office occasionally for training, team meetings, and other departmental needs-giving you the best of both worlds. Why this role matters: As a Claims Examiner, you'll play a key role in helping our members live healthier, more independent lives. By accurately processing claims, you ensure that people receive the care they need-right in their homes and communities. What you'll do: Review and process moderate to complex claims with precision and efficiency. Meet or exceed quality and production standards-your accuracy makes a difference Collaborate with your team, share ideas, and help us continuously improve. Support other departments during busy periods and participate in training to grow your skills. Maintain confidentiality and uphold compliance standards. Work occasional overtime when business needs arise. Your schedule: Daylight hours, Monday-Friday, between 6 a.m. and 5 p.m. No nights, no weekends. Overtime may be required as need for business needs. What we're looking for: Strong attention to detail and ability to prioritize tasks. Comfort working independently in a remote environment while staying connected with your team. A commitment to accuracy, teamwork, and client satisfaction. + High school graduate or equivalent required. + One year of claims processing and/or equivalent education preferred Knowledge of medical terminology, ICD-9, and CPT coding required. + Knowledge of commercial, Medicaid, and Medicare products. + Ability to use a QWERTY keyboard. + Competent in MS Office and PC skills preferred. + Working knowledge of COB (Coordination of Benefits) preferred. + Ability to demonstrate organizational, interpersonal, and communication skills. + Maintain designated production and quality standards required. + Previous computer experience in a professional setting is highly preferred. Licensure, Certifications, and Clearances: UPMC is an Equal Opportunity Employer/Disability/Veteran

Created: 2025-11-24