Job Description

Job Title: Team Leader, Provider Advocate
Job ID: 637457
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Community HealthChoices
Location: 1650 Metropolitan Street, Pittsburgh PA 15233

Description

Purpose:

Do you have a strong customer service and health insurance background?  If so, an opportunity as a Team Lead with UPMC Health Plan's Provider Services team may be the perfect fit for you.  The Team Leader, Provider Advocate acts as an advocate for Health Plan customers (member, provider, facilities, etc.) by providing guidance, interpretation and education on eligibility levels, benefit design, claim status, and various customer related inquires. The Team Leader provides technical support to the Provider Services team by monitoring call/chat queues and overall call volume. The Team Leader will assist with achieving all call center standards. The Team Leader will make recommendations for team/individual training and mentor new Provider Advocates. The Team Leader will assess call trends and make recommendations to improve overall customer satisfaction. The Team Leader must understand the root cause of customer (provider) concerns and have the ability to effectively communicate these findings to Call Center Management, or other Health Plan departments. The Team Leader will work with excellent customer service at the forefront of their actions. The Team Leader is responsible for efficient and courteous resolution to verbal/written inquiries while maintaining all call service and quality standards. The Team Leader will handle adjustment requests from all internal/external Provider sources. The Team Leader will troubleshoot, track, trend and resolve problems for the providers. The Team Leader will create special claim projects from provider trends.

Responsibilities:
  • Act as the liaison between Network Management, Providers and Operations
  • Analyze and summarize special projects utilizing Microsoft Excel
  • Assist in ongoing training initiatives for all Team Members. Serve as a mentor as assigned for newly hired staff members
  • Assist with the achievement of phone/chat call quality to meet/exceed the quality standards;
  • Assist with the counseling process as requested;
  • Conduct outbound calls to clarify, follow up and resolve inquiries from customers in accordance with departmental initiatives
  • Consistently review team results, provide feedback, make recommendations and implement action plans to meet standards;
  • Document all inquiries in accordance with UPMC Health Plan guidelines
  • Facilitate bi-weekly team meetings and provide information to staff in a timely manner
  • Follow up on/documents actions required to service inquiry from UPMC Health Plan customers
  • Front line analyst for Staff Member questions or concerns;
  • Function as technical expert for their team; Ability to understand and effectively communicate information regarding multiple or complex product line or function:
  • Interact professionally with all customers by telephone or correspondence to answer inquiries and resolve concerns
  • Investigate and respond to incoming inquiries from UPMC Health Plan customers, internal/external
  • Meet deadlines and turnaround times set by managers and department director (these deadlines and turnaround times will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended work weeks, or both)
  • Monitor and manage workflows to facilitate communication and teamwork between departments
  • Monitor and report on issues/trends in the unit; Maintain reports to assist in achievement of standards; identify root cause of potential or existing problems
  • Participate in interviewing, hiring and training of team members when requested
  • Partner with Network Management in building effective working relationships with key providers
  • Provide daily communication to team members related to processing/departmental changes; meet with team members on an ongoing basis to review trends and quality/production results
  • Provide exemplary customer service by being proactive and responsive to all UPMC Health Plan customer requests
  • Remain current on all departmental policies, procedures, plan benefit designs and modifications
  • Solve problems and provider immediate feedback to Staff Members/Internal/External Customers;
  • Support and develop cross-functional team members

Qualifications

  • High school diploma required. Bachelor degree preferred. 
  • Three plus years of call center and/or claims processing experience; at least two years in Managed Care/Insurance Industry, or Benefit Administration environment. 
  • Excellent knowledge in medical terminology, ICD-9 and CPT coding required. 
  • Competent in claims process operating system. 
  • Ability to prioritize and perform multiple tasks while ensuring designated production and quality standards are met. 
  • Excellent knowledge of UPMC Health Plan's internal department functions. 
  • Excellent organizational, interpersonal and communication skills. Able to demonstrate organizational, analytical, interpersonal and communication skills.
  • Microsoft Office/PC skills required.
  • Previous health insurance call center experience is strongly preferred.

Licensure, Certifications, and Clearances:
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $18.24 to $30.32

Union Position: No

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

QUALITY & SAFETY
DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
EXCELLENCE & INNOVATION

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