Escalation Response Specialist II

Centene Corporation; North Carolina; Sur place; USD 42 000 - 54 000; Plein temps

Avantages offerts par ce poste

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Remote, hybrid, field or office work

Résumé du poste

Centene Corporation is seeking a role focused on responding to member and provider complaints and escalations. The position supports escalation handling, problem tickets, and provides feedback to senior team members to improve processes.

Responsibilities include timely resolution of escalated issues, cross-functional coordination, and documentation of inquiries. The role may require weekend work during peak months and strict adherence to policies.

Qualifications

• Must have high school diploma or GED and 1–2 years related experience.
• Preferred: healthcare or health plan experience, call center, phone-based, and call escalation experience.
• Medicare experience is preferred.

Responsabilités

• Provide timely resolutions to escalated issues from multiple channels.
• Liaise between departments to ensure timely issue resolution.
• Document, track, and resolve complaints and inquiries in writing or by phone.
• Support root cause analysis to identify trends and enterprise-wide solutions.
• Coordinate with contact center to research facts and evaluate remedies.

Connaissances

Customer service

Communication

Escalation handling

Team coordination

Formation

High School diploma or GED

Description du poste

Position Purpose: Assists with responding to complaints and escalations from members/providers. Supports in handling escalations, handling problem tickets, and providing feedback to senior team members regarding member/provider issues.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT.

Preferred qualifications include healthcare or health plan experience as well as call center, phone based, and call escalation experience. Medicare experience is preferred.

Role requires candidates during peak months (Sept to March) to be able to work Saturdays and Sundays from 8:00 AM-4:30 PM their local time on a rotational schedule.

• Provides timely and appropriate resolutions to escalated issues received from various communication channels.
• Serves as a liaison in maintaining relationships between departments to ensure timely and appropriate issue resolution.
• Supports the documentation, tracking, and resolution to all assigned complaints and inquiries in writing and/or by telephone in a timely and professional manner.
• Supports root cause analysis of member/provider issues to identify trends across the enterprise, and works cross functionally with all departments to ensure enterprise-wide solutions.
• Helps to coordinate with contact center team to research underlying facts of escalated inquiries, determine validity of complaints and evaluate options to remedy these complaints.
• Reviews complaint trends and uses guidance of senior team members to develop draft recommendations that are designed to enhance member and provider experience and reduce complaints and escalations.
• Maintains basic, introductory knowledge of our products and services to provide accurate and effective support to customers.
• In some instances, researches and identifies basic claims payment errors and make appropriate adjustments.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience: Requires a High School diploma or GED. Requires 1 – 2 years of related experience. May require vocational or technical education in addition to prior work experience. Vocation or technical education may include additional on-the-job training or continuous learning education.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including:

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• a flexible approach to work with remote, hybrid, field or office work schedules

Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act