COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Complaints and Grievances Coordinator I

  • Job ID: 592476995
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Member CGA
  • Location: Work From Home
  • Union Position: No
  • Salary Range: $18.78 to $31.22 / hour

Description

UPMC Health Plan is hiring a full-time Complaints and Grievances Coordinator I to help support the Complaints and Grievances Department for its downtown Pittsburgh location at the US Steel Tower. This is a Monday through Friday daylight position. The team is currently working remotely but may eventually return to the office. 

In this role, you will be responsible for tracking, trending and managing member complaints and grievances, and provider appeals for all product lines. You will also ensure the efficient and effective resolution of member complaints and
grievances, and provider appeals as well as use the data collection and analysis to target initiatives for opportunities for
improvement within the Health Plan. 

Responsibilities:

 

  • Organize all tasks within regulatory requirements/deadlines.
  • Understand and interpret medical information, recognize trends, and identify opportunities for improvement within the Health Plan.
  • Effectively utilize key internal and external Health Plan contacts, including: Health Plan staff, providers, and external review organizations, to help in this process.
  • Ensure member and provider concerns are thoroughly and accurately addressed according to regulatory guidelines.
  • Investigate member complaints and grievances, and provider appeals, and respond in writing according to department standards.
  • Coordinate and facilitate review hearings and internal appeal committee meetings or prepare Independent Review Entity case files dependent on Line of Business.
  • Support implementation of appeals tracking system.
  • Assist in reporting complaint and grievance data to appropriate regulatory bodies and internal departments.

 

Qualifications

  • Associate degree or equivalent professional work experience
  • 1 year of experience in health care environment required.
  • Medical claims and/or customer service background preferred.
  • Demonstrated success problem solving and decision making with a solid understanding of managed care principles.
  • Excellent verbal and written presentation skills are essential.
  • PC literacy with proficiency in the use of Microsoft office products.
  • Familiarity with ICD-10, HCPCS, and CPT4 coding and medical terminology.


Licensure, Certifications, and Clearances:

  • Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

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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.

   Current UPMC employees must apply in HR Direct

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