Job Description

Job Title: Customer Service Analyst
Job ID: 81070428
Status: Full-Time
Regular/Temporary: Regular
Hours: Varying start times between 8pm-8am
Shift: Night Job
Facility: UPMC Health Plan
Department: TPA Engage_Enroll
Location: 1650 Metropolitan Street, Pittsburgh PA 15233

Description

Act as an advocate for all Health Plan employees by providing guidance, interpretation and education on benefit coverage levels, claims payment, claims adjustment, and various programs inquiries. Serve as a mentor and quality coach for newly hired and existing staff members to ensure service excellence. Interface with internal and external customer via phone and/or correspondence to answer inquiries and resolve concerns for all lines of business. Review, investigate and adjust claims for all product lines.

Responsibilities:
  • Maintain employee and insured confidentiality.
  • Serve as a mentor and/or coach as assigned for newly hired and existing staff members to ensure service excellence.
  • Support all call center units according to business need.
  • Must be flexible with responsibilities and have an exceptional ability to multitask.
  • Conduct outbound calls to clarify follow up, and resolve inquiries from internal and external customers.
  • Investigate, document, and bring to resolution, all customer inquiries in accordance with UPMC Health Plan Resource Unit's guidelines.
  • Work directly with call center trainers/quality facilitators/supervisors and managers to determine training needs. Assist with training as needed.
  • Ability to move between product lines or service centers as required by department needs.
  • Analyze reports; identify trending issues and training opportunities within the Health Plan.
  • Provide impeccable customer service by being proactive and responsive to all UPMC Health Plan internal and external customer requests.
  • Communicate effectively in both verbal and written interactions.
  • Interpret and investigate claim processing issues; makes adjustments as necessary for all lines of business.
  • Remain current on all departmental policies, procedures, plan benefit designs and modifications.
  • Serve as a role model of service excellence by supporting a positive call center atmosphere.

Qualifications

  • High school graduate or equivalent required, college degree preferred.
  • Minimum of 2-5 years of at least one of the following; health insurance experience, internal customer service, call center experience, claim processing and/or claims adjustments.
  • 2 years claims processing/adjustment background preferred.
  • 2 years health insurance call center experience strongly preferred - internal UPMC Health Plan experience is a plus.
  • Demonstrate a positive and professional attitude at all times.
  • High level knowledge of all lines of business, Medicare, Medicaid and Commercial benefits. 
  • Knowledgeable in medical terminology, ICD-9 and CPT coding.
  • Excellent written and verbal communication skills. 
  • Proficiency in typing is required. 
  • Ability to make independent decisions.  
  • Knowledge of Microsoft Office, Access and Excel spreadsheet program preferred.
  • Excellent organizational skills. 
  • Maintain an excellent attendance and punctuality record.

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $18.79 to $31.23 / hour

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!

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DIGNITY & RESPECT
CARING & LISTENING
RESPONSIBILITY & INTEGRITY
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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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