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Job Description

Job Title: Complaints and Grievances Intake Coordinator- Temporary
Job ID: 810268493
Status: Full-Time
Regular/Temporary: Temporary
Hours:
Shift: Day Job
Facility: UPMC Health Plan
Department: Complaints & Grievances
Location: 600 Grant St, Pittsburgh PA 15219

Description

UPMC Health Plan is hiring a temporary Complaints and Grievances Intake Coordinator 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 successful candidate will manage accurate and timely case entry and classification in the Complaints and Grievances (C&G) information system. Accurately maintain C&G data files.

Responsibilities:
  • Respond and address incoming messages via department inboxes, emails, faxes, or phone in an accurate and prompt manner.
  • Complete data entry into various information systems to support C&G processes.
  • Conduct case intake process, via cases received through verbal and written requests, and set up new cases in the C&G information system.
  • Accurately and promptly assess, enter and maintain documents in files and/or databases to assure that information is organized and readily available.
  • Identify and escalate priority and expedited issues to management within a timely manner.
  • Access multiple health plan systems to assist with case classification.
  • Retrieve, copy, collate, and file various documents associated with the complaints and grievances processes.
  • Classify member and provider complaints/appeals based on line of business and appeal rights by completing appropriate investigation with may include outbound contact, as needed.
  • Triage and respond to inquiries as appropriate or distribute as needed.
  • Support the team's efforts to improve performance against measured service operation goals.
  • Support implementation of appeals tracking system

Qualifications

  • High school graduate or equivalent required
  • 2 year of work experience in claims or customer service preferred, 5 years preferred
  • Managed care or health insurance experience preferred.
  • Proficiency in typing required
  • Excellent communication, organizational, and customer services skills
  • Detail-oriented
  • Knowledge with Microsoft Word and Excel
  • Demonstrate a positive and professional attitude at all times
  • Problem solving and decision making skills with a solid understanding of managed care principles
  • Knowledge of all product lines

  • Licensure, Certifications, and Clearances:

    UPMC is an Equal Opportunity Employer/Disability/Veteran

    Licensure, Certifications, and Clearances:

    UPMC is an Equal Opportunity Employer/Disability/Veteran

    Salary Range: $0 / hour

    Union Position: No

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