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Member Complaints & Grievances Intake Coordinator, I

Job Details

UPMC Health Plan has an exciting opportunity for a Member Complaints & Grievances Coordinator, I position in the Member CGA department.  This is a full time position working Monday through Friday daylight hours and is a remote position.

The C&G Coordinator I will manage accurate and timely case entry and classification in the Complaints and Grievances (C&G) information system. Accurately maintain C&G data files.

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.

    Licensure, Certifications, and Clearances:
     

  • Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran

APPLY HERE: Member Complaints & Grievances Intake Coordinator, I

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HR Assistant

Job Details

The Princeton Review is a leading tutoring, test prep, and college admission services company. Every year, it helps millions of college- and graduate school–bound students achieve their education and career goals through online and in-person courses delivered by a network of more than 4,000 teachers and tutors, online resources, and its more than 150 print and digital books published by Penguin Random House. The company’s Tutor.com brand is one of the largest online tutoring services in the U.S. It comprises a community of thousands of tutors who have delivered more than 22 million one-to-one tutoring sessions. The Princeton Review is headquartered in New York, NY. Follow the company on LinkedIn, YouTube and Instagram. 

 

Part-Time 3 Month Temp. HR Assistant

 

Hours Per Week:  30 to 40

No Overtime unless approved

3 Month Initially may be extended

 

Location: Remote

FLSA Status: Non-Exempt

 

About The Princeton Review

The Princeton Review is a leading tutoring, test prep, and college admission services company. Every year, it helps millions of college- and graduate school-bound students achieve their education and career goals through online and in-person courses delivered by a network of more than 4,000 teachers and tutors, online resources, and its more than 150 print and digital books published by Penguin Random House. The company’s Tutor.com brand is one of the largest online tutoring services in the U.S. It comprises a community of thousands of tutors who have delivered more than 22 million one-to-one tutoring sessions. The Princeton Review is headquartered in New York, NY. Follow the company on LinkedIn, YouTube and Instagram.

 

About the Position

The HR Assistant provides day-to-day administrative support to the People Operations team. This role is the first point of contact for routine employee questions and is responsible for accurate data entry, file maintenance, and timely processing of standard HR transactions. The HR Assistant works under close supervision, follows established procedures, and escalates non-routine matters to senior team members. This role plays an important part in supporting data accuracy, employee experience, and the smooth operation of HR systems and programs.

 

What You’ll Do

 

HR Inbox & Employee Support

  • Monitor the shared HR inbox and respond to routine, Tier 1 employee questions using established templates and FAQs
  • Route more complex tickets to the People Operations Coordinator or HR Manager for resolution
  • Distribute pre-approved HR communications to employees as directed
  • Use the existing HR ticketing system to track and update inquiries

 

 

Benefits Administration Support

  • Send enrollment forms and benefits materials to new hires and during open enrollment
  • Collect, review for completeness, and maintain benefits enrollment documentation
  • Enter benefits elections into the HRIS and submit to carriers per established procedures
  • Forward complex benefits questions and claim issues to the People Operations Coordinator or broker
  • Provide administrative support for benefits of communications and wellness initiatives

HRIS, Payroll & Reporting

  • Help support Rippling Implementation.
  • Process new hire records, terminations, and standard employee updates in Rippling under supervision
  • Run canned/standard HR reports as requested by the People Operations team
  • Maintain accurate employee data records and assist with routine data audits and clean-up
  • Provide employee data support for payroll processing as requested
  • Answer routine employee questions about pay stubs, direct deposit, and tax forms (W-4, W-2 reissues)
  • Utilize templates, AI-enabled tools and knowledge resources to improve response efficiency and support employee self-service

HR Operations & Administration

  • Maintain electronic and physical employee files in compliance with retention requirements
  • Complete employment verification requests using standard templates
  • Process tutor rehires, transfers, and reinstatements following established checklists
  • Process paid sick leave requests using the standard intake form
  • Distribute the existing Employee Handbook and policy documents; flag content needing updates to the People Operations Coordinator

Compliance & Audit Support

  • Maintain files and documentation needed for internal and external audits
  • Support audits and reconciliations performed by senior team members
  • Help ensure adherence to standard recordkeeping practices and internal policies

Cross-Functional Support & Projects

  • Provide administrative support to special projects, system implementations, and process improvements as directed
  • Forward documents to and from vendors, brokers, and third-party administrators
  • Partner with the People Operations team and internal stakeholders on routine, recurring needs

Who You Are

  • 0–1 year of administrative experience; HR internship or coursework a plus
  • High school diploma or GED required; Associate degree or progress toward a Bachelor’s degree preferred
  • Strong attention to detail and comfort with repetitive, high-volume data entry
  • Proficient in Microsoft Office and Google Workspace; comfortable learning new HR systems and technology platforms (prior Rippling exposure is a plus, not required)
  • Comfortable learning and using new technologies, automation tools, and AI-assisted workplace applications
  • Excellent written and verbal communication skills for employee support and routine correspondence
  • Strong customer service mindset with the ability to communicate professionally and empathetically with employees
  • Ability to handle confidential and sensitive employee information with professionalism, discretion, and attention to data privacy
  • Ability to prioritize tasks, manage multiple requests, and meet deadlines in a fast-paced environment
  • Comfortable working in a remote environment, following structured processes, and escalating issues appropriately
  • Eagerness to learn and grow within a People Operations function

The Princeton Review and Tutor.com offer a competitive salary which commensurates with experience and skills. 

US Pay Range

$17 – $19 USD

The Princeton Review is an equal employment opportunity employer. The Princeton Review’s policy is not to discriminate against any applicant or employee based on, and all qualified applicants will receive consideration for employment without regard to, race, color, religion, national origin, sex, sexual orientation, gender identity or expression, age, marital status, disability, military status, genetic information, or any other basis protected by applicable law. The Princeton Review also prohibits harassment of applicants or employees based on any of these protected categories. It is also The Princeton Review’s policy to comply with all applicable laws respecting consideration of unemployment status in making hiring decisions.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.

APPLY HERE: HR Assistant

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Patient Support Advocate

Job Details

This position is Remote in Mountain or Pacific Time Zone. You will have the flexibility to work remotely* as you take on some tough challenges. 

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

As a Patient Support Center Representative, you will be responsible for acting as a patient advocate to help resolve patient issues pertaining to claims, benefit referrals, physicians and access. You will also be responsible for managing high volume of inbound calls, enter patient information into information systems, and resolve caller’s issues with outstanding customer service skills. In addition, serve as a liaison between the patient and other departments and Optum sites.

This position is full time (40 hours / week). Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am – 8:00 pm, Monday – Friday OR 8:00 am – 6:00 pm PST, Saturday – Sunday. It may be necessary, given the business need, to work occasional overtime. 

We offer 30 to 90 days of paid training. The hours of training will be 8:00 am – 5:00 pm, Monday – Friday. Training will be conducted virtually from your home.   

 

Primary Responsibilities:

  • Consistently exhibits behavior and communication skills that demonstrate Optum’s commitment to superior customer service, including quality, care and concern with each and every internal and external customer
  • Multi-task utilizing double monitors for data entry, phone etiquette, and use of resources while maintaining proper guidelines
  • Provides services to internal and external customers involving the exchange of complex and sensitive information while acting as patient advocate
  • Assists other Patient Support Center Representatives and Supervisors with daily paperwork load as needed to resolve and/or document patient issues
  • Recognizes financial, medical and legal risks based on data collected during customer interactions and follows appropriate procedures
  • Meet department goals which include but not limited to call volume, accuracy, quality, and attendance
  • Utilizes Optum systems to resolve customer needs such as appointments, authorizations, claims, invoices, eligibility, benefits, appeals, TARs
  • Translates oral information into concise and accurate written documentation per guidelines
  • Assists new or potential members in the choice of PCP and supplies general information about medical group
  • Pages clinicians and assists Telehealth Nurses as necessary (e.g., arranging DME, transportation and HH)
  • Data enters PCP changes into the system and processes paperwork as necessary

 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

  • High School Diploma / GED OR equivalent experience
  • Must be 18 years of age OR older
  • 1+ years of working in a customer service-based role
  • Ability to use the Microsoft Office Suite and other systems proficiently
  • Ability to work full-time (40 hours / week). Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am – 8:00 pm, Monday – Friday OR 8:00 am to 6:00 pm PST, Saturday – Sunday. It may be necessary, given the business need, to work occasional overtime.  

 

Preferred Qualifications:

  • 1+ years of working in a healthcare setting
  • Bilingual fluency in English and Other language

 

Telecommuting Requirements:

  • Reside within Mountain or Pacific Time Zone
  • Ability to keep all company sensitive documents secure (if applicable)
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy  

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.15 – $28.80 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

 

#RPO 

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Patient Support Specialist

Job Details

 

ocation

Remote

Employment Type

Full time

Location Type

Remote

Department

Patient Support

Compensation

  • $20 – $21 per hour • Potential for quarterly bonus

Tier 1 specialists handle all phone calls, emails, and SMS messages from patients answering questions about PhilRx, the PhilRx process, or about their specific prescription order. This includes status updates, pricing explanations, technical support with the My.Phil account, enrollment support, outbound calls/emails to collect additional required information, etc.

 

Tier 1 specialists work collaboratively with the Psup leadership and PhilRx teams to resolve issues in a timely manner. They are expected to be capable of reviewing and understanding the status of an order quickly to educate the patient in response to their inquiry.

 

The ideal candidate will be one who can navigate multiple software systems quickly and easily, has excellent written and verbal communication skills, and is adaptable, open to feedback, and would do anything within policy and reason to help get the situation solved for the patient. The ideal candidate must also be resilient, and not take patient anger or frustration personally.

 

Responsibilities:

  • Be signed into Zendesk, and consistently working in the ticket and phone queues assigned by your team lead.

  • Use your resources in the Zendesk Guide knowledgebase to locate the answers to patient questions, and for process steps to complete work.

  • When unable to locate documentation, ask for support using chat groups in order to provide a timely response to the patient.

  • Minimum performance metrics required after 90 days of work:

    • Obtain 85% or better CSAT ratings

    • Achieve less than 1% error rate

    • Complete 10 tickets/calls per hour

    • Adhere to the published work schedule >94% of the time

    • Other metrics may be assigned upon management discretion

 

Requirements:

  • Minimum 1 year of customer support experience (call center experience is preferred).

  • Minimum 1 year of healthcare experience, preferably in enrollments or insurance

  • Strong attention to detail, with experience in an environment with low/no tolerance for errors

  • Strong phone presence with exemplary customer service skills

  • Strong written comprehension and written communication skills

  • Capable of quickly searching knowledgebase to locate answers

  • Familiar with following complex processes, and navigating multiple software systems during their workday

  • Must have a good understanding of computers, hardware, networks, etc.

  • Adaptable to swift changes

  • Open to giving and receiving feedback graciously and professionally

 

Schedule:

  • Patient Support Business Hours are 6a-6p PST Monday-Friday, and 6a-3p PST on Saturdays, Sundays and holidays. We are open 365 days per year. Employees must be available for any shift within business hours, but employees are provided a regular shift that would only change with notice.

  • Overtime may be available, and will occasionally be required.

  • Holiday work may be required if there aren’t enough volunteers to cover the shift.

 

Benefits:

  • Ground floor opportunity with one of the fastest-growing startups in health-tech

  • Fully remote working environment available in the following states: AZ, CA, CO, FL, GA, IA, ID, IL, IN, MA, MI, MO, NC, NH, NJ, NY, OH, OK, OR, PA, SC, TN, TX, UT, VA, WA, WI, WV

  • Competitive compensation (commensurate with experience)

  • Full benefits (medical, dental, vision)

  • 401(k)

 

APPLY HERE: Patient Support Specialist

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