Job Description
Description
The DMR Claims Service Specialist I is responsible for the resolution of Health Plan Subscriber submitted claims while meeting or exceeding the designated production and quality standards. The DMR Claims/Service Specialist I validates the information on all medical claims submitted by UPMC Health Plan members seeking out of network reimbursement. Responsibilities include thoroughly reviewing claims to ensure there is no missing or incomplete information, manually entering claims into the claims processing system and complete outreaches to members or providers requesting all missing documentation. In addition, the DMR Claims/Service Specialist I must provide exceptional customer service while responding to inbound or outbound member calls regarding interpretation and education on claims processing outcome.
Responsibilities:
Qualifications
Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran
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