Job Description

Job Title: Health Care Concierge, Senior
Job ID: 13994290
Status: Full-Time
Regular/Temporary: Regular
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: CM ENROLLMENT
Location: 600 Grant St, Pittsburgh PA 15219

Description

The Health Care Concierge, Senior is an advocate for all Health Plan members by providing guidance, interpretation and education on benefit coverage levels, claims payment, claims adjustment, and various programs inquiries. Serve as a mentor and coach newly hired and existing staff members to ensure service excellence. Interface with internal and external customers via phone and/or correspondence to answer inquiries and resolve concerns for all lines of business. Investigate, document, and bring to resolution all customer inquiries and identify root cause for member issues.

Responsibilities:

  • Remain current on all departmental policies, procedures, plan benefit designs, and modifications.
  • Ability to understand and effectively communicate information regarding three product lines or function including benefits and claims information.
  • Provide impeccable customer service by being proactive and responsive to all UPMC Health Plan internal and external customer requests.
  • Communicate effectively with excellent verbal and written interactions/skills.
  • Drive First Call Resolution on every inquiry by completing all necessary outreach calls on behalf of the member.
  • Serve as a role model of service excellence by supporting a positive call center atmosphere.
  • Identify root cause for member issues and seek resolution with our internal departments.
  • Assist with the first call recovery process as needed for service recovery initiatives.
  • Conduct outbound service calls in accordance with departmental initiatives.
  • Follow up on and document actions required to service inquiry from UPMC Health Plan members, prospective members and providers.
  • Serve as a mentor to newly hired staff members to role model excellent customer service, documentation and follow-up as required by the department.
  • Service and document inquiries in accordance with UPMC Health Plan quality guidelines.
  • Attend all member service meetings, trainings and power summits as scheduled.
  • Service multiple product lines and complete cross training to meet the needs of the business.
  • Manage multiple member inquiries across interaction types including telephonic, fax, online, chat, web messages and email.
  • Provide exemplary customer service by being proactive and responsive to all UPMC Health Plan customer requests.
  • Claims interpretation skills with the ability to learn and understand claims processing.
  • Support team members by assisting on the Resource unit and provide coaching as needed and identifying potential training opportunities.
  • Investigate, document, and bring to resolution, all customer inquiries in accordance with UPMC Health Plan Resource Unit's guidelines.
  • Support other departments as needed.
  • Must be flexible with responsibilities and have an exceptional ability to multitask.

Qualifications

  • High school graduate, Associates or college degree preferred
  • Minimum of 4 years of customer service experience required
  • 2 years health insurance call center experience required
  • Internal UPMC Health Plan experience preferred
  • High level knowledge of health insurance on 3 lines of business preferred
  • Ability to identify root cause, escalate and resolve complex member issues
  • Thorough understanding of Member and Provider Services and all health plan entities
  • Ability to mentor new hires to be successful and identify areas of opportunity for training and development
  • Ability to schedule and conduct power summits amongst the team
  • Demonstrate a positive and professional attitude
  • Preferred knowledgeable in medical terminology, diagnosis and procedure codes
  • Thorough understanding of claims processing required
  • 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
  • Flexibility in work schedule to manage the queue in the evenings and on the weekends

    Licensure, Certifications, and Clearances:

    UPMC is an Equal Opportunity Employer/Disability/Veteran

Salary Range: $16.72 to $26.54 / hour

Union Position: No

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