Community HealthChoices (CHC) is Pennsylvania's managed care long term services and supports (LTSS) program serving seniors and individuals with physical disabilities in the Commonwealth, as well as dual-eligible individuals covered by Medicare and Medicaid.
Work with users and developers to identify problems and propose solutions. Maintain project planning documents, prepare materials, write and distribute workflow, maintain UPMC systems portfolio (checklist).
Ability to analyze benefit administration issues to determine the need for and the scope of polices and procedures.
Assist other departments during periods of backlogs.
Develop administration policies and procedures or business recommendations to ensure uniform, cost effective claims administration practices that comply with the law, plan documents and other company policies.
Effectively prioritize and complete all assigned tasks.
Identify areas of concern that may compromise client satisfaction.
Maintain employee/insured confidentiality.
Maintain project planning, model business requirements for new systems and enhancements to existing systems.
Openly participate in team meetings, provide ideas and suggestions to ensure client satisfaction, and promote teamwork.
Participate in training programs as available/requested.
Work with users and developers to identify problems and propose solutions.
Bachelors degree or equivalent related work experience required.
Minimum of two years of general business experience required.
Minimum of two years of experience in business/industry specialty required. Knowledge of commercial, Medicaid, and Medicare products preferred.
Competent in MS Office and PC skills preferred.
Working knowledge of COB (Coordination of Benefits) preferred.
Organizational, interpersonal, and communication skills required.
Licensure, Certifications, and Clearances:
UPMC is an equal opportunity employer. Minority/Females/Veterans/Individuals with Disabilities