Emily Duchow Email & Phone Number

Pittsburgh, PA

• Oversee administrative and system processes as they relate to benefit plan design, implementation, training and maintenance for all UPMC Health Plan product lines. Serve as domain expert and technical resources to.
• Administer, test and implement benefit plans on transactional systems.
• Conduct transactional system functional enhancement testing, including electronic data interchange functions.
• Coordinate and resolve system relates issues impacting claims adjudication. Maintain automated adjudication processes, identifies deficiencies and implements improvements.
• Interface with customers by telephone, correspondence, and or in person to answer inquiries and resolve concerns to assure customer satisfaction.
• Manage, update and maintain source data dictionaries as they related to benefit plan processes.

Pittsburgh, PA

Customer Service Analyst II for UPMC Health Plan Pharmacy Services. Acted as an advocate for all Health Plan employees by providing guidance, interpretation, and education on pharmacy benefit coverage, payments, claims processing, and various programs inquiries. Served as a mentor and coach to member service representatives across all lines of business.

Pittsburgh, PA

• Job functions included:
• Provided customer service support to UPMC Health Plan's Department of Pharmacy Services.
• Interacted with physicians, pharmacists, and members to obtain information pertinent to the decision-making process.
• Explained Health Plan sponsored benefits, and assist with pharmacy claims processing functions.
• Investigate and troubleshoot issues regarding pharmacy claims processing.
• Worked on all aspects of the prior authorization process: receiving, reviewing, and evaluating for quality assurance when complete.

Cranberry Township, PA

Associate'S Degree, Business Administration And Management, General, 3.0

Education record