Job Description

Job Title: Customer Service Representative
Job ID: 87073905
Status: Full-Time
Regular/Temporary: Regular
Hours: Varying Shifts between 8pm-8am
Shift: Night Job
Facility: UPMC Health Plan
Department: TPA Engage_Enroll
Location: 1650 Metropolitan Street, Pittsburgh PA 15233

Description

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.

Responsibilities:
  • 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.
  • Remain current on all departmental policies; procedures plan benefit designs, and modifications.
  • Coordinates members' use of the complaint process and assists Members, as needed, at all levels of the complaint process according to policy.
  • Provides information regarding Community Care operations and answers any questions. Responds to member inquiries and describes member rights and responsibilities.
  • 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.
  • Conducts self in a manner consistent with the mission and philosophy of the organization at all times.
  • Receives member and provider complaints, attempts resolution, and logs data.
  • Provide exemplary customer service by being proactive and responsive to all Community Care member requests.
  • 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.
  • Interacts and coordinates with all areas of the organization.
  • May engage in the acquisition or transfer of structured clinical data, but does not engage in any activities that involve clinical evaluation or interpretation.
  • 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.
  • Provides members with updated information, changes to the network, benefit plan or procedures.
  • Makes outreach calls under supervision of care management staff.
  • Contacts assigned members for various outreach and follow up initiatives.
  • Determines if the member needs intervention by the Care Manager for emergent or urgent situations as directed by protocol.

Qualifications

  • High school diploma or equivalent required, some college preferred.
  • Minimum of 6 months of customer service and/or call center experience, behavioral health call center a plus.
  • 2 years of customer service and/or call center experience strongly 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
  • General knowledge of computers required. 
  • Microsoft windows environment

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $14.97 to $23.54 / hour

Union Position: No

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