Senior Customer Service Representative(Job Number: 008NU)Description Using current reference materials, answer inquiries from members and/or providers regarding claims, eligibility, covered benefits, authorizations and pharmacy related mattersProvide assistance to members and/or providers regarding website registration and navigation Educate members and/or providers on health plan initiatives during telephone conversationsProvide first call resolution; working with appropriate internal/external resources, completing necessary follow-up, and ensuring closure of the inquiryDocument all activities for quality and metrics reporting through the Customer Relationship Management (CRM) applicationIdentify trends related to member and/or provider inquiries to respond proactively and provide feedback to managementProcess 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 processesProcess forms required to release pending claims to providersWork with other departments on cross functional tasks and projectsMaintain performance and quality standards based on established call center metrics including turn-around timesQualifications Education/Experience: High school diploma or equivalent. 3 years of call center 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.
Website : http://www.centene.com
Founded as a single health plan in 1984, Centene Corporation (Centene) has established itself as a national leader in the healthcare services field. Today, through a comprehensive portfolio of innovative solutions, we remain deeply committed to delivering results for our stakeholders: state governments, members, providers, uninsured individuals and families, and other healthcare and commercial organizations