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For more information about UPMC's response to COVID-19, please visit upmc.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Health Care Concierge, Senior-WFH

  • Job ID: 312671827
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: 8:30a.m. to 5:00p.m.
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: TPA Engage_Enroll
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $17.05 to $27.07 / hour

Description

UPMC has an exciting opportunity for a Health Care Concierge, Senior position located at 1650 Metropolitan St. Pittsburgh, PA 15233.  This is a  full time work from home position Monday through Friday 8:30am to 5:00pm 

 
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 or equivalent required.
  • Associates or college degree preferred.
  • Minimum of 4 years with at least one of the following; 1yr of Internal HP experience with high level knowledge on all LOBs, health insurance experience, internal customer service/call center experience, claim processing and/or claims adjustments preferred. 
  • 2 years claims processing/adjustment background preferred.
  • 2 years health insurance call center experience strongly preferred - internal UPMC Health preferred.
  • Demonstrate a positive and professional attitude at all times.
  • High level knowledge of health insurance for all lines of business.
  • Health Plan experience.
  • Preferred knowledgeable in medical terminology, ICD-10 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.
  • Flexibility in work schedule.

    Licensure, Certifications, and Clearances:

    UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life &emdash; because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

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