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   Current UPMC employees must apply in HR Direct

Complaints and Grievances Coordinator I (Remote)

  • Job ID: 123844332
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Complaints & Grievances
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $18.24 to $30.32 / hour

Description

UPMC Health Plan is seeking a full-time Complaints and Grievances Coodinator!


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 work-from-home role. 


Responsibilities:

 

  • Organize all tasks within regulatory requirements/deadlines.
  • Understand and interpret medical information, recognize trends, and identify opportunities for improvement within the Health Plan.
  • Effectively utilize key internal and external Health Plan contacts, including: Health Plan staff, providers, and external review organizations, to help in this process.
  • Ensure member and provider concerns are thoroughly and accurately addressed according to regulatory guidelines.
  • Investigate member complaints and grievances, and provider appeals, and respond in writing according to department standards.
  • Coordinate and facilitate review hearings and internal appeal committee meetings or prepare Independent Review Entity case files dependent on Line of Business.
  • Support implementation of appeals tracking system.
  • Assist in reporting complaint and grievance data to appropriate regulatory bodies and internal departments.

 

Qualifications

  • Associate degree or equivalent professional work experience
  • One (1) year of experience in health care environment is required.
  • 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-10, HCPCS, and CPT4 coding and medical terminology.


Licensure, Certifications, and Clearances:

UPMC is an Equal Opportunity Employer/Disability/Veteran

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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