Customer Service Representative Ccbh – Sunday-Thursday, Day/Evening (Remote)

UPMC Community Care Behavioral Health is seeking a full-time Customer Service Representative to support the CCBH Member Services Department within the Commonwealth of Pennsylvania!

The Customer Service Representative (CSR) will be able to work completely from home, as long as they have a private, secure home office space to protect the privacy of customers/members and their information. Individuals hired into this role must live within Pennsylvania, with candidates within approximately one hour of a CCBH office being prioritized.

The CSR will have a 6-week training program, with hours of 8 a.m. to 4:30 p.m., Monday through Friday. Following training, the CSR will work a set shift of 12:30 p.m. to 9 p.m., Sunday through Thursday. This is a shift differential-eligible shift! 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, interpersonal, and technical computer skills are vital to the role.

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.
• Remains current on all departmental policies, procedure 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 describe members’ rights and responsibilities.
• Documents inquiries in accordance with Community Care Customer Service guidelines.
• Facilitates members’ access to services by scheduling appointments and/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.
• Provides 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 plans, 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.

• High School diploma or equivalent required.
• Minimum of 6 months of Customer Service and/or call center experience.
  • Behavioral Health call center experience is a plus!
• Proficient computer skills, including Microsoft Office products, strongly preferred.
• Previous experience with Teams and/or virtual platforms strongly preferred.
• Proficiency in typing required.
• Basic analytical skills necessary to evaluate caller inquiries.
• Strong interpersonal and verbal skills required.
• Ability to work independently and multitask required.
• Demonstrates good organizational skills.
• General knowledge of computers required.
• Microsoft Windows environment.

Licensure, Certifications, and Clearances:

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran