Top 89 Claims specialist Jobs in Pittsburgh Pa

Senior Specialist, Integrated Absence Manager
New York Life —Pittsburgh, PA
- $50,000 - $73,000 a year
- Full-time
- Hybrid work
- Microsoft Outlook
- Writing skills
- Mid-level
- Free parking
- Health insurance
1d
Pharmacy Benefits /Insurance Claims Specialist | Onsite- Pittsburgh
Blink Health —Pittsburgh, PA
- 12 hour shift
- Research
- Office
- High school diploma or GED
- Free parking
- Commuter assistance
Quick Apply
Insurance Resolution Specialist
Pantherx Specialty LLC —Pittsburgh, PA
- Full-time
- Hybrid work
- Mid-level
- In-person
- 2 years
- Paid holidays
- Disability insurance
Quick Apply
Patient Access Specialist
Ensemble Health Partners —Pittsburgh, PA
- $17.00 - $19.70 an hour
- Full-time
- Background check
- Hospital
- Customer service
- Paid training
- Wellness program
Quick Apply
Payroll Specialist - Onsite Pittsburgh, PA
SMS group Inc —Pittsburgh, PA
- Full-time
- Pass drug screening
- Mid-level
- Office
- Paid holidays
- Health insurance
Quick Apply
Lost Time Claims Specialist II (FL & GA)
UPMC —Pittsburgh, PA
- $27.89 - $48.21 an hour
- Full-time
- Remote
- Mid-level
- Analysis skills
- Bachelor's degree
Workers Compensation Claims Specialist, Sr
NJM Insurance Group —Pittsburgh, PA
- $79,129 - $91,834 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- 5 years
- Paid parental leave
- Disability insurance
Lost Time Claims Specialist II (VA, MD, PA, and DC)
UPMC —Pittsburgh, PA
- $27.89 - $48.21 an hour
- Full-time
- Mid-level
- Analysis skills
- Bachelor's degree
Professional Conduct Investigator 1
Commonwealth of PA —Pittsburgh, PA
- $53,008 - $80,646 a year
- Full-time
- Mid-level
- Bachelor's degree
- Experience equivalent to degree accepted
- Paid parental leave
- Health insurance
2d
Claims Processing Specialist - Tarentum, PA
Blackburn's Physicians Pharmacy, Inc. —Tarentum, PA
- Full-time
- Computer literacy
- Mid-level
- Office
- Profit sharing
- Paid holidays
Quick Apply
Environmental Protection Specialist
Commonwealth of PA —Pittsburgh, PA
- $60,538 - $92,010 a year
- Full-time
- Mid-level
- Office
- Master's degree
- Paid parental leave
- Health insurance
13d
Specialist, EHS
EOS Energy Storage —Turtle Creek, PA
- Full-time
- Mid-level
- Associate's degree
Behavioral Health Absence Specialist
UPMC —Pittsburgh, PA
- $27.89 - $48.21 an hour
- Full-time
- LMFT
- Computer literacy
- Licensed Clinical Social Worker
Registration Specialist, Internal Medicine
WMCP WMC Physician Practices —Crafton, PA
- Full-time
- Internal Medicine
- High school diploma or GED
- Criminal background check
Lead Project Management Specialist
GE Vernova —Charleroi, PA
- $87,000 - $145,000 a year
- Full-time
- Microsoft Word
- Pass drug screening
- Mid-level
- Paid parental leave
- Paid holidays
Administrative Specialist
New York Life —Pittsburgh, PA
- $38,000 - $43,000 a year
- Overtime
- Hybrid work
- Microsoft Outlook
- Ability to sit for extended periods
- Data entry
- Loan repayment program
- Disability insurance
14d
Billing Specialist
Cornerstone Care —Mc Kees Rocks, PA
- $21 - $22 an hour
- Full-time
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Authorization Specialist (Pediatric Genetic and Genomic Medicine)
UPMC —Pittsburgh, PA
- $20.00 - $30.55 an hour
- Full-time
- Mid-level
- High school diploma or GED
- Children
Payroll & Benefits Specialist
Brentwood Bank —Bethel Park, PA
- Full-time
- Hybrid work
- Mid-level
- Office
- 3 years
Quick Apply
ORTHOTICS PATIENT CARE SPECIALIST
ēlizur —Pittsburgh, PA
- Full-time
- Mid-level
- High school diploma or GED
- Organizational skills

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Senior Specialist, Integrated Absence Manager

New York Life -
Pittsburgh, PA

Apply Now

Job Details

Full-time
$50,000 - $73,000 a year
1 day ago

Benefits

Free parking
Health insurance
Dental insurance
401(k)
Tuition reimbursement
Paid time off
Employee assistance program
Vision insurance
401(k) matching
Professional development assistance
Life insurance
Retirement plan

Qualifications

Customer communication
Microsoft Outlook
High school diploma or GED
Attention to detail
Organizational skills
Technical Proficiency
Time management

Full Job Description

Work Schedule:
The first 7 weeks of training will take place onsite at The Vision (116 15th Street, Pittsburgh, PA 15222), Monday through Friday. After training, employees will be evaluated. Once they demonstrate proficiency, the role will transition to a hybrid schedule: Remote: Mondays and Fridays, and Onsite: Tuesday, Wednesday & Thursday.

Role Overview:

As an Integrated Absence Manager, you will be assigned a caseload of concurrent cases (paid/unpaid leave and Short-Term disability plans) managing all aspects of an employee’s absence. The Integrated Absence Manager will conduct thorough investigations, determine eligibility for our customers, provide ongoing Absence administration, and communicate decisions and status updates. This role is responsible for collaborating with customers, health care providers and clients to ensure timely, accurate Absence administration and payments. Upon approval of Absences, you will provide ongoing Absence management services, assist with return-to-work needs, and communicate decisions and status updates with customers and clients both verbal and written.

The Integrated Absence Manager plays a critical role in executing the New York Life Group Benefit Solutions (GBS) promise to our customers and has a direct impact on our customers in the moments that matter. The ability to work in a fast-paced and detail-oriented environment while integrating knowledge of medical conditions, customer contracts, New York Life GBS, and corporate compliance are critical for success.

What You’ll Do:

Responsible for managing a caseload of Absence cases including the management of Short-Term Disability (STD), Paid Family Medical Leave (PFML), Family Medical Leave Act (FMLA), Company Paid Leave (CPL), and Americans with Disability Act of 1990 (ADA) and providing service excellence to GBS customers.
Own and review assigned cases. This includes verifying eligibility, capturing medical information, applying appropriate contractual provisions, following legal guidelines, and leveraging expert resources.
Evaluate available information to make claim and leave determinations within compliance guidelines; pay all covered claims accurately and timely.
Coordinate multiple leave and disability plans using integrated technology.
Support ongoing claim management including extensions and reviewing of additional information as needed to support ongoing claim decisions.
Effectively communicate with claimants, employers, and various medical professionals both verbally and in writing to gather information regarding the application for, payment of, and ongoing management of short-term disability benefits and applicable leave plans.
Respond to all telephonic and email inquiries within customer service protocols and adhere to standard timeframes for processing mail, tasks, and outliers. Execute all customer performance guarantees as defined.
Document clear absence notes in the system based on medical received or conversations with the customer, provider, and client.
Proactively work directly with clients and Vocational Rehabilitation Counselors to facilitate return to work either on a full-time or modified duty basis.
Network with both customers and physicians to medically manage claims from initial medical requests to reviewing and evaluating ongoing medical information.
Execution of New York Life and Corporate Compliance, Policies and Procedures and best practices.
Ongoing development via training associated with role and business unit objectives.

What You’ll Bring:

HS Diploma or GED required. Bachelor’s degree strongly preferred.
2+ years’ experience administering Disability strongly preferred.
Experience administering FMLA and/or State Leaves experience strongly preferred.
Proficiency with MS Office applications is required (Word, Outlook, Excel.)
Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously.
Strong critical thinking, analytical, and investigative skills; ability to gather information, analyze facts, and draw conclusions.
Ability to understand complex absence scenarios and apply them to work.
Ability to work with a bias for action and be a self-starter with a customer-focus mindset.
Effective interpersonal, written, and verbal communication skills including the ability to articulate complex claim scenarios and translate them to easily understandable for customers and clients.
Must be technically savvy with the ability to toggle between multiple applications and/ or computer monitors simultaneously.
Attention to detail is critical to effectively handle the technical aspects of the job.
Excellent planning, time management and organizational skills. Ability to manage multiple and changing priorities.
Strong critical thinking and analytical skills to effectively multi-task and prioritize work to meet tight deadlines.
Strong negotiation skills.
Must be able to work with urgency and be a self-starter with a customer focus mindset.
Ability to build and maintain effective relationships.
Knowledge of legal liability, insurance coverage and medical terminology is helpful.
A proven track record of successfully driving results in a complex matrix environment is required.
Ability to work well under pressure.

Work Schedule:

The first 7 weeks of training will take place onsite at The Vision (116 15th Street, Pittsburgh, PA 15222), Monday through Friday. After training, employees will be evaluated. Once they demonstrate proficiency, the role will transition to a hybrid schedule: Remote: Mondays and Fridays, and Onsite: Tuesday, Wednesday & Thursday.

Onsite Amenities:
Employees working onsite will have access to the following amenities:

Fitness center
Tenant lounge
Nearby retail
Bike storage
Outdoor space
Concierge services
Dry cleaning
EV charging stations
Puttery mini golf
The Roaming Bean Coffee
Tapville Social
Onsite free parking

Pay: $50,000.00 - $73,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Employee assistance program
Health insurance
Life insurance
Paid time off
Professional development assistance
Retirement plan
Tuition reimbursement
Vision insurance

Work Location: In person

Apply Now

Refine Your Search

claims specialist jobs in pittsburgh pa

Senior Specialist, Integrated Absence Manager

Pharmacy Benefits /Insurance Claims Specialist | Onsite- Pittsburgh

Insurance Resolution Specialist

Patient Access Specialist

Payroll Specialist - Onsite Pittsburgh, PA

Lost Time Claims Specialist II (FL & GA)

Workers Compensation Claims Specialist, Sr

Lost Time Claims Specialist II (VA, MD, PA, and DC)

Professional Conduct Investigator 1

Claims Processing Specialist - Tarentum, PA

Environmental Protection Specialist

Specialist, EHS

Behavioral Health Absence Specialist

Registration Specialist, Internal Medicine

Lead Project Management Specialist

Administrative Specialist

Billing Specialist

Authorization Specialist (Pediatric Genetic and Genomic Medicine)

Payroll & Benefits Specialist

ORTHOTICS PATIENT CARE SPECIALIST

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