Job Description

Job Title: QA Reviewer I- Call Center
Job ID: 702782
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Quality Assurance
Location: 600 Grant St, Pittsburgh PA 15219

Description

Purpose:
UPMC Health Plan is hiring a Quality Assurance Reviewer I - Call Center to support its Quality Audit & Review department located at the US Steel Building in downtown Pittsburgh. In this role, you will be responsible for quality review of calls taken by Health Plan Customer Service staff. By serving as the policy and procedure expert, you will work closely with Customer Service staff, the Training Department, and other areas.

This is a Monday through Friday, daylight position. Apply today!


Responsibilities:
  • Identify error trends to make recommendations regarding customer service training needs.
  • Maintain employee/insured confidentiality.
  • Maintain or exceed designated quality and production goals.
  • Monitor and evaluate monitored call center agent calls in accordance with UPMC Health Plan guidelines.
  • Participate in all training programs to develop a thorough understanding of the materials presented to the customer service staff.
  • Responds to the needs of internal Health Plan departments (i.e. claims staff, customer service staff, sales, medical management, etc.) and external customers (i.e. UPMC Medical Center Internal Audit team).

Qualifications

High school graduate or equivalent.

Two to four years customer service experience, preferably in a call center.

Keyboard dexterity and accuracy.

Detail oriented individual with excellent organizational, interpersonal and communication skills.

Ability to maintain designated production and quality standards.

Knowledge of medical terminology, ICD-9 and CPT coding.

Knowledge of HMO, POS, PPO, Medicare, SNP, Chip and Medicaid Plans. Knowledge of MS Office.

Proficiency in MS office/PC skills.

2-4 yrs of health insurance call center and/or general auditing experience preferred.

Licensure, Certifications, and Clearances:
HIA � Health Insurance Associate � preferred.

UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Salary Range: $16.23 to $25.77

Union Position: No

Apply Current Employee?

UPMC VALUES

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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