Position Purpose: Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner.
Using current reference materials, answer inquiries from members and/or providers regarding claims, eligibility, covered benefits, authorizations and pharmacy related matters
Provide assistance to members and/or providers regarding website registration and navigation
Educate members and/or providers on health plan initiatives during telephone conversations
Provide first call resolution; working with appropriate internal/external resources, completing necessary follow-up, and ensuring closure of the inquiry
Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
Identify trends related to member and/or provider inquiries to respond proactively and provide feedback to management
Process and follow through on all matters related to Provider Addition, Change and Termination (PACT) forms, Customer Service Forms (CSFs), and claims projects in a timely manner. Conduct appropriate auditing processes
Process forms required to release pending claims to providers
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. 3 years of combined call center and customer service experience preferably in a healthcare or insurance environment. 1 years of managed care experience preferred.
Associate's degree and claims processing, billing and/or coding experience preferred. Depending on the state, bi-lingual skills may also be preferred.
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.