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   Current UPMC employees must apply in HR Direct

Eligibility Specialist

  • Job ID: 616871218
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: 7:30am-5:30pm
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: CHC Rev Rec & Elig
  • Location: , Pittsburgh PA
  • Union Position: No
  • Salary Range: $18.24 to $30.32 / hour


Community HealthChoices (CHC) is Pennsylvania's managed care long term services and supports (LTSS) program serving seniors and individuals with physical disabilities in the Commonwealth who are covered by Medicare and Medicaid. 

Eligibility specialists may work with Medicare or Medicaid, disability claims, or other government-sponsored programs. Reporting to the Eligibility Manager, you will be responsible for maintaining CHC's membership database. You will process requests from internal and external customers reviewing the request and taking the appropriate action, in a timely and accurate manner. Internal and external clients depend on our accuracy and efficiency when processing client data, so you will be accountable for providing these high levels of service in accordance with the company standards and customer expectations.


  • Strive for first contact resolution through taking ownership of the contact from start to finish
  • Liaise and coordinate with internal customers to ensure a one team approach. Pro-actively identify departmental improvement opportunities and recommend solutions
  • Carry out other ad-hoc tasks as required, to meet business needs. They may even play the role of counselor or advocate by advising people on what aid programs may benefit them and then helping them receive that benefit.
  • Monitor productivity to ensure you are always achieving own and team productivity and accuracy goals
  • Maintain the membership database, by accurately recording and updating information received
  • Communicate directly with clients via email and telephone within the agreed service levels
  • Ensure all membership updates adhere to policy terms and conditions, as well as legal, compliance and underwriting requirements



An associate's or bachelor's degree in business, or related field. Minimum of 3-5 years of experience.Database Entry and/or Database Management experience essential. Experience within a Customer Service environment. Proficient in Microsoft Word, Excel and Outlook - advanced Excel would be advantageous. Experience from an insurance background preferred


  • Medicaid experience
  • Experience with aging population
  • Strong Customer Service experience

Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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   Current UPMC employees must apply in HR Direct