COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC continues to comply with governmental guidance related to local, state, and federal COVID-19 vaccination for employment. All employees and affiliated staff of UPMC entities are considered essential health care workers and will be accountable to follow the Centers for Medicare & Medicaid Services (CMS) federal vaccine mandate. To be compliant with the federal mandate, employees must complete the approved vaccination dosage regimen currently defined by the federal government. Compliance with the federal mandate is encouraged before hire. Medical and religious exemption requests may be submitted for consideration.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Customer Service Analyst

Description

UPMC Health Plan has an exciting opportunity for a full-time Customer Service Analyst to support the Pharmacy Services department. This is a Monday - Friday daylight role (9:30 a.m. - 6:00 p.m.), with occasional Saturday coverage required approximately every 4-7 weeks. This is a hybrid role with remote/work-from-home privileges in PA and some potential travel to the office for trainings, meetings, department needs, etc.


The Customer Service Analyst will act as an advocate for all Health Plan employees by providing guidance, interpretation and education on benefit coverage levels, claims payment, claims adjustment, and various programs inquiries. He/she will serve as a mentor and quality coach for newly hired and existing staff members to ensure service excellence. Interface with internal and external customer via phone and/or correspondence to answer inquiries and resolve concerns for all lines of business. The incumbent will also review, investigate and adjust claims for all product lines.


Responsibilities:

  • Maintain employee and insured confidentiality.
  • Serve as a mentor and/or coach as assigned for newly hired and existing staff members to ensure service excellence.
  • Support all call center units according to business need.
  • Must be flexible with responsibilities and have an exceptional ability to multitask.
  • Conduct outbound calls to clarify follow up, and resolve inquiries from internal and external customers.
  • Investigate, document, and bring to resolution, all customer inquiries in accordance with UPMC Health Plan Resource Unit's guidelines.
  • Work directly with call center trainers/quality facilitators/supervisors and managers to determine training needs. Assist with training as needed.
  • Ability to move between product lines or service centers as required by department needs.
  • Analyze reports; identify trending issues and training opportunities within the Health Plan.
  • Provide impeccable customer service by being proactive and responsive to all UPMC Health Plan internal and external customer requests.
  • Communicate effectively in both verbal and written interactions.
  • Interpret and investigate claim processing issues; makes adjustments as necessary for all lines of business.
  • Remain current on all departmental policies, procedures, plan benefit designs and modifications.
  • Serve as a role model of service excellence by supporting a positive call center atmosphere.

Qualifications

  • High school graduate or equivalent required, college degree preferred.
  • Minimum of 2-5 years of at least one of the following; health insurance experience, internal customer service, call center experience, claim processing and/or claims adjustments.
  • 2 years claims processing/adjustment background preferred.
  • 2 years health insurance call center experience strongly preferred - internal UPMC Health.
  • Demonstrate a positive and professional attitude at all times.
  • High level knowledge of all lines of business, Medicare, Medicaid and Commercial benefits.
  • Plan experience is a plus.
  • Knowledgeable in medical terminology, ICD-9 and CPT coding.
  • Excellent written and verbal communication skills.
  • Proficiency in typing is required.
  • Ability to make independent decisions.
  • Knowledge of Microsoft Office, Access and Excel spreadsheet program preferred.
  • Excellent organizational skills.
  • Maintain an excellent attendance and punctuality record.


Licensure, Certifications, and Clearances:

  • Act 34


    UPMC is an Equal Opportunity Employer/Disability/Veteran

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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