UPMC Data Control Processor in Pittsburgh, Pennsylvania
Do you have experience with project management and data analysis? Are you a Microsoft Excel wizard who has experience generating and analyzing reports? If so, an opportunity as a Data Control Processor with UPMC Health Plan's Commercial Enrollment team may be the perfect fit for you!
The Data Control Processor is a full time position Monday – Friday 9:00 a.m. to 5:00 p.m. This position is located at 600 Grant Street Pittsburgh, PA with the ability to work from home occassionally.
This position creates and maintains eligibility in the transactional system while responding to both internal and external customer inquiries and resolving issues to meet or exceed service requirements. Some administrative work will be performed.
Interact with Medicare and SNP Sales Staff to ensure all CMS required data elements are received and annotated timely.
Identify, print, sort and prepare enrollment documents in preparation for distribution to staff.
Provide clerical support to Medicare Enrollment including filing, copying and faxing.
Prepare and record Medicare Enrollment inventory daily.
Investigate, address and resolve member enrollment and demographic issues to ensure member satisfaction.
Understand processing rules based on the product (HMO, PPO, SNP, PDP, Select, Supplemental, or National Complimentary) and Individual vs. Employer Group
Use Ika/OCE to determine enrollment eligibility and election periods based on CMS (Part A/Part B/Part D Eligibility) DPW (Medical Assistance Dual Eligibility).
Process plan changes and disenrolls in accordance with Federal and State regulatory guidelines.
Sort, count and mail outgoing CMS letters to members.
Must be completed in accordance with CMS, and PID guidelines, while meeting or exceeding production and quality assurance standards.
Maintain employee/insured confidentiality.
Coordinate all incoming paper (i.e. applications, correspondence, etc.).
Data enter new applications into Ika/OCE, which will allow enrollment transactions to process in accordance with Federal and State regulatory guidelines as well as company policies and procedures.
Generate appropriate member correspondence based on type of transaction processed.
High school diploma or equivalent, college degree preferred.
Ability to interpret and apply complex eligibility regulations as mandated by CMS and PID.
Filing and mathematical skills required.
Must possess excellent organizational, interpersonal, and communication skills.
Knowledge of Microsoft Office software preferred.
Licensure, Certifications, and Clearances:
UPMC is an Equal Opportunity Employer/Disability/Veteran
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