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Complaints and Grievances Intake Coordinator

  • Job ID: 332503452
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: 8 am to 4:30 pm
  • Shift: Day Job
  • Facility: UPMC Health Plan
  • Department: Complaints & Grievances
  • Location: 600 Grant St, Pittsburgh PA 15219
  • Union Position: No
  • Salary Range: $15.88 to $24.98 / hour

Description

UPMC Health Plan is hiring a full-time Complaints and Grievances Intake 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 that will predominately work from home with the potential to go into the office as needed.


This person will manage accurate and timely case entry and classification in the Complaints and Grievances (C&G) information system and accurately maintain C&G data files.

Responsibilities:

 

  • Respond and address incoming messages via department inboxes, emails, faxes, or phone in an accurate and prompt manner.
  • Complete data entry into various information systems to support C&G processes.
  • Conduct case intake process, via cases received through verbal and written requests, and set up new cases in the C&G information system.
  • Accurately and promptly assess, enter and maintain documents in files and/or databases to assure that information is organized and readily available.
  • Identify and escalate priority and expedited issues to management within a timely manner.
  • Access multiple health plan systems to assist with case classification.
  • Retrieve, copy, collate, and file various documents associated with the complaints and grievances processes.
  • Classify member and provider complaints/appeals based on line of business and appeal rights by completing appropriate investigation with may include outbound contact, as needed.
  • Triage and respond to inquiries as appropriate or distribute as needed.
  • Support the team's efforts to improve performance against measured service operation goals.
  • Support implementation of appeals tracking system

 

Qualifications

  • High school graduate or equivalent required
  • 2 year of work experience in claims or customer service required, 5 years preferred
  • Managed care or health insurance experience preferred. Proficiency in typing required
  • Excellent communication, organizational, and customer services skills
  • Detail-oriented
  • Knowledge of Microsoft Word and Excel
  • Demonstrate a positive and professional attitude at all times
  • Problem-solving and decision-making skills with a solid understanding of managed care principles
  • Knowledge of all product lines


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