Customer Service Rep CCBH

UPMC Community Care Behavioral Health is seeking full-time Customer Service Representatives to support the CCBH Member Services Department within the Commonwealth of Pennsylvania! There are multiple openings, with the shifts below available.

• Monday, Tuesday, Friday, Saturday 12 pm - 10:30 pm (this will be a 10-hour shift)
• Monday-Friday 12 pm - 8:30 pm 

Holidays are required, as the CCBH Member Services Department is a 24/7 office. There is a volunteer process, but otherwise, holidays are assigned, as needed.

The Customer Services Representative acts as an advocate for Community Care customers (members, providers, facilities, etc.) by providing guidance, interpretation, and education on benefit coverage levels, referrals, and various program inquiries! The ideal candidate for this position will have previous call center experience, while excellent communication and interpersonal skills are vital to the role. Spanish language proficiency is a plus!

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.