Lead Customer Service Representative(Job Number: 1077372)Description Position Purpose: Serve as a liaison between Customer Service Representatives CSRs), management and other various departments. Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner. Investigate and resolve complex claims matters in coordination with health plan and/or corporate departmentsCoordinate the day-to-day work functions, acting as a go to person and investigating and resolving complex issuesInitiate change requests to resolve system configuration questions impacting claims processing; review and test resultsConduct appropriate auditing processesReference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status mattersEducate members and/or providers on health plan initiatives; train and assist providers regarding proper claims billing proceduresProvide first call resolution and own the process by working with appropriate internal/external resources and ensure the closure of all inquiriesDocument 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 managementCollaborate with other departments on cross functional tasks and projects Maintain performance and quality standards based on established call center metrics including turn-around timesQualifications Education/Experience: High school diploma or equivalent. Associate’s degree and claims processing, billing and/or coding experience preferred. 2 years of experience in Medicare, Medicaid managed care or insurance environment preferred. 4 years of customer service experience in a call center environment. Knowledge of managed care software systems (i.e.: CRM, Amisys, TruCare, etc.) preferred. Depending on the state, bi-lingual may 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