UPMC Recruitment – Manager, Claims



This position will lead a Claim Operations production team that focuses on front end processes with downstream impacts. This person will focus on employee and leadership growth/development and work experience, to further cultivate a culture of engagement, while overseeing day-to-day operations. They will also collaborate with senior leaders to optimize department processes and systems while building relationships with stakeholders and customers.

  • Provide leadership and direction through developing and updating procedures, programs, determining appropriate production standards, determining staffing requirements, and training opportunities.
  • Maintenance of communication with new and established customers.
  • Serve as liaison to customers by facilitating demonstrations of operations activities.
  • Effectively interact with internal and external customers.
  • Recruit and discharge employees when necessary.
  • Maintain designated standards established for handling incoming work.
  • Manage and direct all activities and special projects.
  • Provide central coordination and control for implementation of new/changed application and systems.
  • Create programs that promote employee engagement and develop a positive work experience.
  • Develop or manage programs to enhance employee development.


  • Bachelor’s Degree preferred.
  • 5 years of business experience required.
  • Prior management experience with automated claims processing is mandatory.
  • Knowledge of medical terminology, ICD-9, and CPT coding required.
  • Knowledge of commercial, Medicaid, and Medicare products.
  • Competent in MS Office and PC skills. Able to demonstrate organizational, interpersonal, and communication skills.
  • Maintain designated production and quality standards.
  • Ability to react to users needs in a timely and efficient manner.
  • Direct staff with minimal amount of supervision.

Licensure, Certifications, And Clearances

  • Act 34
  • UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards 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.

Job Details:

Company: UPMC

Job Type: Full Time

Job Location: Pittsburgh, PA

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