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   Current UPMC employees must apply in HR Direct

Data Control Processor

Description

UPMC Health Plan has an exciting opportunity for a Data Control Processor! In this role, the Data Control Processor will create and maintain eligibility in the transactional system (MC400), responding to both internal and external customer inquiries, and resolving issues to meet or exceed service requirements.

Responsibilities:

  • Interact with Medicare and SNP Sales Staff to ensure all CMS required data elements are received and annotated timely.
  • Identify, print, sort and prepare enrollment documents in preparation for distribution to staff.
  • Provide clerical support to Medicare Enrollment including filing, copying and faxing.
  • Prepare and record Medicare Enrollment inventory daily.
  • Investigate, address and resolve member enrollment and demographic issues to ensure member satisfaction.
  • Understand processing rules based on the product (HMO, PPO, SNP, PDP, Select, Supplemental, or National Complimentary) and Individual vs. Employer Group
  • Use Ika/OCE to determine enrollment eligibility and election periods based on CMS (Part A/Part B/Part D Eligibility) DPW (Medical Assistance Dual Eligibility)
  • Process plan changes and disenrolls in accordance with Federal and State regulatory guidelines.
  • Sort, count and mail outgoing CMS letters to members.
  • Must be completed in accordance with CMS, and PID guidelines, while meeting or exceeding production and quality assurance standards.
  • Maintain employee/insured confidentiality.
  • Coordinate all incoming paper (i.e. applications, correspondence, etc.).
  • Data enter new applications into Ika/OCE, which will allow enrollment transactions to process in accordance with Federal and State regulatory guidelines as well as company policies and procedures.
  • Generate appropriate member correspondence based on type of transaction processed.

 

Qualifications

  • High school diploma or equivalent, college degree preferred.
  • Ability to interpret and apply complex eligibility regulations as mandated by CMS and PID.
  • Filing and mathematical skills required.
  • Must possess excellent organizational, interpersonal, and communication skills.
  • Knowledge of Microsoft Office software preferred.


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 — 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