Customer Service Representative (Part Time)

UPMC Community Care Behavioral Health is hiring a part-time Customer Service Representative for its Member Services Department. The role handles member and provider inquiries and complaints, facilitates access to services, and conducts initial crisis triage according to established protocols before referring cases requiring clinical intervention to a licensed Care Manager.

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

Requirements:

• Must be legally authorized to work in the United States, without requiring, now or in the future, sponsorship for employment visa status
• High school diploma or equivalent required
• Minimum of 6 months of customer service and/or call center experience required
• 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
• Act 34
• some college preferred
• 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
• Spanish language proficiency is a plus