Note: The job is a remote job and is open to candidates in USA. UPMC Community Care Behavioral Health provides behavioral health services in Pennsylvania and is seeking a Customer Service Representative for its Member Services Department. The role handles inbound member and provider calls in a high-volume behavioral health triage call center, conducts initial crisis triage and stabilization, documents inquiries, supports access to services, and coordinates with care management staff.
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
Skills
- Must be legally authorized to work in the United States, without requiring, now or in the future, sponsorship for employment visa status
- This role works remotely and requires a quiet, private room with a door and reliable internet with a speed test prior to hire
- Holidays are required, as the CCBH Member Services Department is a 24/7 office
- 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
Benefits
- Part-time employment
- Remote work arrangement
Company Overview