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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 and is required after employment begins. 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

Health Care Concierge, Intermediate

Description

UPMC Hralth Plan has an exciting opportunity for a Health Care Concierge, Intermediate position in the Government Enrollment Department.  This is a full time position working Monday through Friday daylight hours.  The will be a work from home (telework) position.

The Health Care Concierge, Intermediate services complex health insurance products across at least two lines of business & acts as an advocate for Health Plan customers (member, provider, facilities, etc.) by providing guidance, interpretation and education on benefit coverage levels, claims payment, and various program inquires. In addition, the Health Care Concierge, Intermediate can serve as a mentor for newly hired staff members and able to manage special assignments to meet member/department needs.

Responsibilities:

  • Handle special projects as assigned.
  • Drive First Call Resolution on every inquiry by completing all necessary outreach calls on behalf of the member.
  • Follow up on and document actions required to service inquiry from UPMC Health Plan members, prospective members and providers.
  • Service two product lines of business and complete cross training as scheduled.
  • Answer and investigate incoming inquiries from UPMC Health Plan members, prospective members and providers.
  • Provide exemplary customer service by being proactive and responsive to all UPMC Health Plan customer requests.
  • Serve as a mentor to newly hired staff members to role model excellent customer service, documentation and follow-up as required by the department
  • Conduct outbound service calls in accordance with departmental initiatives.
  • Service and document inquiries in accordance with UPMC Health Plan quality guidelines.
  • Ability to understand and effectively communicate information regarding a product line or function including benefits and claims information
  • Claims interpretation skills with the ability to learn and understand claims processing.
  • Attend all member service meetings, trainings and power summits as scheduled.
  • Remain current on all departmental policies, procedures, plan benefit designs, and modifications.
  • Manage multiple member inquiries across interaction types including telephonic, fax, online, chat, web messages and email.

 

Qualifications

  • High school graduate, Associates or college degree preferred.
  • Minimum of 3 years of customer service experience and/or call center experience.
  • Knowledge of Member and Provider Services required.
  • Ability to service 2 lines of business to meet the member services department needs.
  • Demonstrate the ability to go above & beyond to help members.
  • Mentor new hires to be successful.
  • Proficiency in typing required.
  • Strong writing skills required.
  • Ability to make independent decisions required.
  • Knowledge of Microsoft Office and Excel spreadsheet program required.
  • Complex analytical skills required to assist customer inquiries.
  • Demonstrates good organizational skills.
  • A desire to help others and portray empathy in all situations.
  • Ability to learn & articulate complex health plan information.
  • Demonstrate flexibility and motivation to learn & grow in the position.
  • Flexibility in work schedule.


Licensure, Certifications, and Clearances:

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