Customer Service Representative II(Job Number: 1077374)Description 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 mattersProvide assistance to members and/or providers regarding website registration and navigationEducate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources, and ensure closure of all inquiriesDocument 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 adjustmentIdentify 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 standardsWork 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. 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 customer 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.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.
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