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Full-time
high school
Posted 9d ago
~40 hrs/week
Responsibilities
The Provider Advocate acts as a liaison for health plan customers by providing guidance on eligibility, benefit design, and claim status. They are responsible for resolving inquiries efficiently while maintaining high quality and service standards.
Requirements
Candidates must have a high school diploma or equivalent and at least two years of customer service or call center experience. Proficiency in medical terminology, coding, and health insurance plan structures is required.
Full job description
UPMC Health Plan is hiring a team of Provider Advocates to support the Provider Services department. This is a full-time hybrid position based in the Erie, PA area. While you’ll primarily work remotely, you’ll come into the office occasionally depending on departmental needs. Must be located in or around Erie, PA to be considered.
The Provider Service representative acts as an advocate for Health Plan customers (providers, vendors, facilities, etc.) by providing guidance, interpretation and education on eligibility levels, benefit design, claim status, and various customer related inquires. Responsible for efficient and courteous resolution to verbal and written inquiries to ensure customer satisfaction while maintaining call servicing and quality standards.
Responsibilities:
Actively maintain worklist open cutlogs and follow up within the designated time standards.
UPMC Health Plan Provider Service Representative must adhere to the following service level standards of excellence: Quality: 98%25 Monthly Average - Production: 60 calls per day.
Maintain employee/insured confidentiality.
Provide assistance to other departments during periods of backlogs.
Assist with adjustments in accordance with company policies and procedures.
Quality customer service will be measured by, but not limited to, the number of complaints from a customer (with a goal of zero) and by the number of second requests for information or response received (with a goal of zero).
Interface with customers by telephone or correspondence to answer inquiries and resolve concerns.
Quality customer service includes, but is not limited to, responding to customer requests and inquiries in a timely and accurate manner in keeping with Health Plan Policies and Procedures, Department of Public Welfare (DPW) laws and standards, Department of Insurance (DOI) laws and standards, Department of Health (DOH) laws and standards, Department of Health and Human Services (DHHS), Health Care Financing Administration (HCFA), and National Committee for Quality Assurance (NCQA) standards.
Quality customer service should be applied to all customers, including all Health Plan members and potential members, all Health Plan providers and potential providers, all Health Plan and Health System employees, all Health Plan and Health System vendors, and all government and other oversight organization staff.
Identify any area of concerns that may compromise client satisfaction.
Maintain or exceed designated quality standards.
Participate in team meetings, provide ideas and suggestions to ensure client satisfaction and promote teamwork.
High school graduate or equivalent.
2 years customer service experience or call center experience required. OR 1 year health insurance call center and claims adjustments experience required.
Keyboard dexterity and accuracy.
Excellent knowledge of medical terminology, ICD-9 and CPT-4 coding.
Excellent knowledge of HMO, POS and PPO plans, coordination of benefits, subrogation and Medicare.
Excellent organizational, interpersonal and communication skills.
Competent in MS Office/PC skills.
Detail Oriented.
Licensure, Certifications, and Clearances:
Act 34
UPMC is an Equal Opportunity Employer/Disability/Veteran
UPMC is a world-renowned, nonprofit health care provider and insurer committed to delivering exceptional, people-centered care and community services. Headquartered in Pittsburgh and affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC is shaping the future of health through clinical and technological innovation, research, and education. Dedicated to advancing the well-being of our diverse communities, we provide nearly $2 billion annually in community benefits, more than any other health system in Pennsylvania. Our 100,000 employees — including more than 5,000 physicians — care for patients across more than 40 hospitals and 800 outpatient sites in Pennsylvania, New York, and Maryland, as well as overseas. UPMC Insurance Services covers more than 4 million members, providing the highest-quality care at the most affordable price. To learn more, visit UPMC.com.
Offices: US Steel Tower, 600 Grant Street, Pittsburgh, PA 15219, US
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Based on 2846 listings with disclosed salaries, most healthcare jobs in Pennsylvania pay between $64k–$181k per year. Individual offers vary with seniority, company size, and specialization.
How many Healthcare jobs are open in Pennsylvania right now?
There are currently 29,438 open healthcare positions in Pennsylvania listed on Clera. New openings are added daily as companies post roles.
Which companies are hiring for Healthcare roles in Pennsylvania?
Companies currently hiring include UPMC, CVS Health, Temple Health – Temple University Health System, Allegheny Health Network, EmmUcare Home Health, among others. Browse the listings above to see every active employer.
Are there remote or hybrid Healthcare jobs in Pennsylvania?
Yes — 2853 of the 29438 open healthcare positions offer remote or hybrid work (973 remote, 1880 hybrid).
How do I apply for Healthcare jobs in Pennsylvania?
Each listing links directly to the employer's application page. Apply early — fresh listings get the most recruiter attention in the first two weeks.