Customer Service Rep CCBH @ UPMC | Jobright.ai
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UPMC · 4 hours ago

Customer Service Rep CCBH

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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

Find out how your skills align with this job's requirements. If anything seems off, you can easily click on the tags to select or unselect skills to reflect your actual expertise.

Customer service experienceCall center experienceTyping proficiencySpanish language proficiencyBehavioral health knowledgeGeneral computer knowledgeMicrosoft Windows

Required

High school diploma or equivalent required
Minimum of 6 months of customer service and/or call center experience
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
Microsoft windows environment
Act 34

Preferred

Some college preferred
Behavioral health call center a plus
Spanish language proficiency is a plus

Company

UPMC is one of the leading nonprofit health systems in the United States. A $10 billion integrated global health enterprise headquartered

Funding

Current Stage
Late Stage

Leadership Team

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Leslie Davis
President and CEO
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Frederick M. Hargett
Chief Financial Officer
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Company data provided by crunchbase
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