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 escalate 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. UPMC is an Equal Opportunity Employer/Disability/Veteran --- _This job was found on [bandana.com](https://www.bandana.com/?utm_source=jd_attribution&utm_medium=repost)_