[Hiring] Customer Service Representative @UPMC

Role Description

UPMC Community Care Behavioral Health is seeking a part-time Customer Service Representative to support the CCBH Member Services Department within the Commonwealth of Pennsylvania! This role will primarily work Monday - Friday 9 am - 1 pm EST. Holidays are required, as the CCBH Member Services Department is a 24/7 office.

This role works remotely and requires a quiet, private room with a door and reliable internet with a speed test prior to hire. In the event of equipment or internet issues, you will be required to report to your nearest Community Care office (there are multiple throughout PA) within a specific time frame.

This role is based in a dynamic, high-volume Behavioral Health (BH) triage call center, responsible for receiving inbound calls from both members and providers. The position involves handling emotionally intense and high-acuity situations, including conducting initial crisis triage assessments. Calls requiring further clinical intervention are transitioned to a licensed Care Manager following initial triage and stabilization protocols.

The ideal candidate for this position will have previous call center experience and experience with Pennsylvania healthcare providers and community resources. Spanish language proficiency is a plus.

Responsibilities

• Maintains comprehensive understanding of member benefits, covered benefits, limitations, exclusions, policies and procedures, computer screens and code definitions, and maintains current awareness of plan changes and developments.
• Remain current on all departmental policies; procedures plan benefit designs, and modifications.
• Coordinates members' use of the complaint process and assists Members, as needed, at all levels of the complaint process according to policy.
• Provides information regarding Community Care operations and answers any questions. Responds to member inquiries and describes member rights and responsibilities.
• Document inquiries in accordance with Community Care Customer Service guidelines.
• Facilitates members' access to services by scheduling appointments or arranging transportation through the Medical Assistance Transportation Program or the PHMCO, when needed.
• Conducts self in a manner consistent with the mission and philosophy of the organization at all times.
• Receives member and provider complaints, attempts resolution, and logs data.
• Provide exemplary customer service by being proactive and responsive to all Community Care member requests.
• Works with the care management staff, and other staff as appropriate, to develop necessary materials; special projects; member/provider alerts; and ability to discuss new procedures with members and providers.
• Interacts and coordinates with all areas of the organization.
• May engage in the acquisition or transfer of structured clinical data but does not engage in any activities that involve clinical evaluation or interpretation.
• Collects information from members concerning problems with accessing services and/or benefits and uses that information to recommend modifications to plan policies and procedures to improve the service to members.
• Provides members with updated information, changes to the network, benefit plan or procedures.
• Makes outreach calls under supervision of care management staff.
• Contacts assigned members for various outreach and follow up initiatives.
• Determines if the member needs intervention by the Care Manager for emergent or urgent situations as directed by protocol.

Qualifications

• High school diploma or equivalent required, some college preferred.
• Minimum of 6 months of customer service and/or call center experience required. Preference will be given to those with 1+ year experience.
• Experience working with Pennsylvania Medicaid, Community HealthChoices, HealthChoices, or Pennsylvania behavioral health programs preferred.
• Familiarity with Pennsylvania healthcare providers and community resources preferred.
• Behavioral health and/or call center experience is a plus.
• Proficient in typing required.
• Basic analytical skills necessary to evaluate caller inquiries.
• Strong interpersonal and verbal skills required.
• Ability to work independently required.
• Demonstrates good organizational skills.
• General knowledge of computers required.
• Familiarity with Microsoft Windows environment.

Licensure, Certifications, and Clearances

• Act 34

Company Description

UPMC is an Equal Opportunity Employer/Disability/Veteran.