Job Description

Job Title: Customer Service Representative - Community Care Behavioral Health
Job ID: 670637
Status: Full-Time
Regular/Temporary: Regular
Hours: 9:00 p.m. to 8:30 a.m.
Shift: Night Job
Facility: Community Care Behavioral Hlth
Department: Member Services
Location: 339 Sixth Avenue, Pittsburgh PA 15222

Description

Do you have a passion for customer service? If so, an opportunity as a Customer Service Representative with Community Care Behavioral Health may be the perfect fit for you!

The Customer Services Representative acts as an advocate for Community Care customers (member, provider, facilities, etc.) by providing guidance, interpretation, and education on benefit coverage levels, referrals, and various program inquiries as part of our 24/7, 365 call center which includes overtime and holiday hours as needed. This position will work an overnight schedule with alternating weekends.


Responsibilities:
  • Collects information from members concerning problems with accessing services and/or benefits and uses that information to recommend modifications to plan policies and procedures to improve the service to members.
  • Conducts self in a manner consistent with the mission and philosophy of the organization at all times.
  • Contacts assigned members for various outreach and follow up initiatives.
  • Coordinates members' use of the complaint process and assists Members, as needed, at all levels of the complaint process according to policy.
  • Determines if the member needs intervention by the Care Manager for emergent or urgent situations as directed by protocol.
  • Document inquiries in accordance with Community Care Customer Service guidelines.
  • Facilitates members' access to services by scheduling appointments or arranging transportation through the Medical Assistance Transportation Program or the PHMCO, when needed.
  • Interacts and coordinates with all areas of the organization.
  • Maintains comprehensive understanding of member benefits, covered benefits, limitations, exclusions, policies and procedures, computer screens and code definitions, and maintains current awareness of plan changes and developments.
  • Makes outreach calls under supervision of care management staff.
  • May engage in the acquisition or transfer of structured clinical data, but does not engage in any activities that involve clinical evaluation or interpretation.
  • Provide exemplary customer service by being proactive and responsive to all Community Care member requests.
  • Provides information regarding Community Care operations and answers any questions. Responds to member inquiries and describes member rights and responsibilities.
  • Provides members with updated information, changes to the network, benefit plan or procedures.
  • Receives member and provider complaints, attempts resolution, and logs data.
  • Remain current on all departmental policies; procedures plan benefit designs, and modifications.
  • Works with the care management staff, and other staff as appropriate, to develop necessary materials; special projects; member/provider alerts; and ability to discuss new procedures with members and providers.

Qualifications

  • High school diploma or equivalent required, some college preferred.
  • Proficient in typing required.
  • Basic analytical skills necessary to evaluate caller inquiries.
  • Strong interpersonal and verbal skills required.
  • Ability to work independently required.
  • Demonstrates good organizational skills.
  • Minimum of 6 months of customer service and/or call center experience, behavioral health call center a plus.
  • General knowledge of computers required. Microsoft windows environment

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

Salary Range: $14.53 to $22.86

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

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.



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