UPMC - Medical Only Claims Specialist I (Remote) - Pittsburgh, PA

Other Jobs To Apply

[adinserter block="1"] Job title: Medical Only Claims Specialist I (Remote) Company: UPMC [adinserter block="1"] Job description: Description UPMC and Workpartners has an exciting opportunity for a Medical Only Claims Specialist I. This is a Monday through Friday daylight role (regular, full-time) with remote work arrangements. The UPMC WorkPartners Workers' Compensation Medical Only Claims Specialist 1 reports to the Workers' Compensation Supervisor. This is an entry level position within the Workers' Compensation Claims Department. The Medical Only Claims Specialist 1 is responsible for coverage analysis, investigation, evaluation, communication, and disposition of assigned medical claims within the WorkPartners Workers' Compensation business unit. The Medical Only Claims Specialist 1 will ensure claims are processed within company policies, procedures, and within individual's prescribed authority following established best practices and performance standards. Responsibilities: Manage non-complex and non-problematic medical-only and restricted medical only, claims under close supervision. Additional duties as required. Appropriate state licensing to be secured as needed. Excellent communication skills. Adhere to client and carrier guidelines and special handling requests. Communicate claim status with the injured worker, insured/employer, and broker as needed. Prepare and present for insured/employer claim reviews outlining claims status and action plans with oversight from supervisor Receives claim, confirms policy coverage and acknowledgement of the claim Evaluate claim, calculate and establish appropriate reserves and review on a regular basis to ensure adequacy for exposure under close supervision. Establish reserves and authorize payments within authority limits. Investigate the claims through telephone, written correspondence, and/or personal contact with injured workers, insureds/employer witnesses and others having pertinent information. Review invoices and medical records to determine eligibility for payment or denial. Determine validity and compensability of the claim. Participate in periodic claim reviews as needed. Participate in monthly account renewal meetings as needed. Qualifications Bachelor's and/or advanced degree or a minimum of 1 year of administrative, claims, and/or customer service experience, preferably in Workers' Compensation. Administrative and claims experience strongly preferred. Demonstrated verbal and written communications skills. Demonstrated analytical and decision making skills. Appropriate state licensing to be secured as needed. Excellent communication skills. Licensure, Certifications, and Clearances: UPMC is an Equal Opportunity Employer/Disability/Veteran Total Rewards More than just competitive pay and benefits, package cares for you in all areas of life — because we believe that you're at your best when receiving the support you need: professional, personal, financial, and more. Our Values At UPMC, we're driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today. Current UPMC employees must apply in [adinserter block="1"] Expected salary: $20 - 33.22 per hour Location: Pittsburgh, PA [adinserter block="1"] Apply for the job now! [adinserter block="1"]

Back to blog

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

Data Entry Question and Answer

$150 $49

Remote Question and Answer

$150 $49

Virtual Assistant Question and Answer

$150 $49

Content Moderator Question and Answer

$150 $49

Customer Service Question and Answer

$150 $49

Video Game Tester Question and Answer

$150 $49

Related Posts