UPMC · 1 day ago
Customer Service Rep (Behavioral Health)
Pittsburgh, PA
Full-time
Onsite
New Grad, Entry Level
0+ years expUPMC Community Care Behavioral Health is seeking full-time Customer Service Representatives to support the CCBH Member Services Department. This role involves receiving inbound calls, handling crisis triage assessments, and providing exemplary customer service to members and providers.
BiotechnologyHealth CareHospitalMedical
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
Qualification
Required
High school diploma or equivalent
Minimum of 6 months of customer service and/or call center experience
Proficient in typing
Basic analytical skills necessary to evaluate caller inquiries
Strong interpersonal and verbal skills
Ability to work independently
Demonstrates good organizational skills
General knowledge of computers required. Microsoft windows environment
Preferred
1+ year of customer service and/or call center experience
Behavioral health experience
Spanish language proficiency
Company
UPMC
UPMC is one of the leading nonprofit health systems in the United States. A $10 billion integrated global health enterprise headquartered
10001+ employees
H1B Sponsorship
UPMC has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (7)
2023 (4)
2022 (7)
2021 (7)
2020 (13)
Funding
Current Stage
Late StageTotal Funding
$0.46MKey Investors
Appalachian Regional Commission
2024-09-18Grant· $0.46M
Leadership Team
Leslie Davis
Chief Executive Officer
Frederick M. Hargett
Chief Financial Officer
Recent News
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