You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
What you’ll do:
- Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner
- Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
- Provide assistance to members and/or providers regarding website registration and navigation
- Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources, and ensure closure of all inquiries
- Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
- Process written customer correspondence and provide the appropriate level of follow-up in a timely manner
- Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustment
- Identify trends related to member and/or provider inquiries that may lead to policy or process improvements that support excellent customer service and impact quality and performance standards
- Work with other departments on cross functional tasks and projects
- Maintain performance and quality standards based on established call center metrics including turn-around times
What you should have:
- High school diploma or equivalent.
- Associates degree and claims processing, billing and/or coding experience preferred.
- 1+years of experience in Medicare, Medicaid managed care or insurance environment preferred.
- 2+ years ofcustomer service experience in a call center environment. Knowledge of managed care programs and services preferred.
- Depending on the state, bi-lingual skills may also be preferred.