Position Purpose: 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
Education/Experience: 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 of combined customer service experience a and call center environment. Knowledge of managed care programs and services preferred. Depending on the state, bi-lingual skills may also be preferred.
For Foundation Care Only: Ability to complete Missouri Registered Pharmacy Tech application on 1st day of hire to obtain non-restricted Missouri Registered Pharmacy Tech within 30 days of hire OR Active Missouri Registered Pharmacy Tech license.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.