Temporary Member C&G Intake Coordinator- Remote

UPMC Health Plan, Inc.; United States; Remote; USD 23,000 - 32,000; Full time

Job summary

UPMC Health Plan is seeking a Temporary Member Complaints and Grievances Intake Coordinator for a six-month remote assignment. The role is full-time, Monday through Friday, with a fixed hourly pay of $20.00.

Responsibilities include accurate data entry, case classification, and timely responses to member inquiries while complying with regulatory standards. You will work across multiple systems to support C&G processes.

Qualifications

• High school diploma or equivalent.
• Two years of work experience in claims or customer service.
• Proficiency in typing.
• Excellent communication, organizational, and customer service skills.
• Detail-oriented with knowledge of Word and Excel.

Responsibilities

• Conduct case intake and set up new cases in the C&G system.
• Classify member complaints/appeals by line of business and regulatory rules.
• Investigate which may include prior appeals, claims, authorizations, and calls.
• Respond promptly to follow-ups for compliance and satisfaction.
• Address member/provider concerns per regulatory guidelines and deadlines.
• Navigate multiple health plan systems to support accurate classification.

Skills

Typing

Communication skills

Organizational skills

Customer service

Problem solving

Tools

Microsoft Word

Microsoft Excel

Job description

UPMC Health Plan has an exciting opportunity for a Temporary Member Complaints and Grievances Intake Coordinator position.

This is a full time temporary opportunity working Monday through Friday daylight hours and will be a remote position.

The Intake Coordinator will manage accurate and timely case entry and classification in the Complaints and Grievances (C&G) information system. Accurately maintain C&G data files.

This will be a 6 month temporary opportunity with a set pay of $20.00/hr.

Responsibilities:

• Conduct case intake process for statements received through verbal and written requests and set up new cases in the C&G information system.
• Classify member complaints/appeals based on line of business/product according to department and regulatory standards and appeal rights.
• Completing appropriate investigation which may include investigation of previous appeals, claims, authorizations, and inbound calls.
• General understanding for the different appeal rights associated with each line of business.
• A prompt response to all follow-up needs on every case is vital, for compliance needs as well as member satisfaction.
• Ensure member and provider concerns are thoroughly and accurately addressed according to regulatory guidelines.
• Organize all tasks within regulatory requirements/deadlines.
• Access and navigate multiple health plan systems to support accurate case classification, including MHK, MC400, Skygen, Health Planet, FileNet, CCD, PA Hub, and HP Capture and Route.
• Additionally, utilize PA Keystone State resources to properly review and process member Fair Hearing documentation.
• Accurately and promptly assess, enter, and maintain documents in files and/or databases to assure that information is organized and readily available.
• Respond and address incoming messages via department FileNet folders, emails, fax system, or phone CUTs in an accurate and prompt manner.
• Triage and respond to inquiries as appropriate or note and distribute as needed.
• Retrieve, copy, collate, and file various documents associated with the complaints and grievances processes.
• Identify and elevate priority and expedited issues to all product leadership within a timely manner.
• Support the team’s efforts to improve performance against measured service operation goals.
• Complete data entry into various information systems to support C&G processes.
• Entering coverage determinations into systems of record.
• The ability to quickly adapt to system outages and issues by identifying effective workarounds and maintaining operational continuity.
• Support implementation of appeals tracking system.

Qualifications:

• High school graduate or equivalent required.
• Two years of work experience in claims or customer service required.
• Five years of managed care or health insurance experience preferred.
• Proficiency in typing required.
• Excellent communication, organizational, and customer services skills.
• Detail-oriented, knowledge with Microsoft Word and Excel.
• Demonstrate a positive and professional attitude.
• Problem solving and decision-making skills with a solid understanding of managed care principles.
• Knowledge of all product lines and ability to follow decision tools to assist with appropriate classification of all product lines and regulatory rules.
• Critical thinking skills are crucial, as every case and investigation needs may vary, depending on member statements and other investigation findings.
• Ability to remain flexible and responsive as requirements and case-handling expectations change regularly.