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   Current UPMC employees must apply in HR Direct

Complaints and Grievances Coordinator I - Temporary- Remote

Description

UPMC Health Plan is hiring a temporary Complaints and Grievances 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 track, trend and manage member complaints and grievances, and provider appeals for all product lines. Ensure the efficient and effective resolution of member complaints and grievances, and provider appeals. Use the data collection and analysis to target initiatives for opportunities for improvement within the Health Plan.

This is a 90 day remote assignment. 

Responsibilities:

  • Assist in reporting complaint and grievance data to appropriate regulatory bodies and internal departments.
  • Effectively utilize key internal and external Health Plan contacts, including: Health Plan staff, providers, and external review organizations, to help in this process.
  • Facilitate second level review hearings and internal appeal committee meetings.
  • Investigate member complaints and grievances, and provider appeals, and respond in writing according to department standards.
  • Organize all tasks within regulatory requirements/deadlines.
  • Understand and interpret medical information, recognize trends, and identify opportunities for improvement within the Health Plan.

 

Qualifications

  • Associate degree or equivalent professional work experience preferred
  • 1 year of experience in health care environment preferred
  • At least one year of experience with Health Insurance Medical claims is preferred.
  • Medical claims and/or customer service background preferred.
  • Demonstrated success problem solving and decision making with a solid understanding of managed care principles.
  • Excellent verbal and written presentation skills are essential.
  • PC literacy with proficiency in the use of Microsoft office products.
  • Familiarity with ICD-9, HCPCS, and CPT4 coding and medical terminology

    Licensure, Certifications, and Clearances:
  • Act 34 Criminal Clearance or Act 34 Criminal Clearance with Renewal


UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct