Remote Escalation Resolution Specialist III

Centene Corporation; Illinois; Remote; USD 45,000 - 65,000; Full time

Job summary

Centene Corporation in the United States is seeking a detail-oriented professional to respond to complaints and escalations from members or providers. This remote role requires strong written and verbal communication, root cause analysis, and the ability to coordinate with multiple departments to resolve issues promptly.

You will document, track, and resolve inquiries, provide timely updates to stakeholders, and help identify trends to improve member experience.

Qualifications

• Requires a High School diploma or GED.
• Requires 2–4 years of related experience.
• Vocational or technical education may include additional on-the-job training or continuous learning education.

Responsibilities

• 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
• Documents, tracks, resolves, and responds to all assigned complaints and inquiries in writing and/or by telephone in a timely and professional manner
• Conducts and monitors root cause of member or provider issues to identify trends across the enterprise, and works cross functionally with all departments to ensure enterprise-wide solutions
• Coordinates with contact center team to research and review underlying facts of escalated inquiries, determine validity of complaints, and evaluate options to remedy these complaints
• Leverages complaint trends to develop recommendations that are designed to enhance member and provider experience and reduce complaints and escalations
• Provides timely status update reports to members and internal stakeholders to support transparency and improve the customer experience
• Maintains up-to-date knowledge of our products and services to provide accurate and effective support to customers
• In some instances, researches and identifies basic and more complex claims payment errors and make appropriate adjustments to claims
• In some instances, collaborates with the Claims department to price paid claims correctly and/or to send claims to the Claims department for corrections
• In some instances, collaborates with other various business units to resolve claims issues to ensure prompt, accurate claims adjudication
• Performs other duties as assigned

Skills

Written communication

Verbal communication

Root cause analysis

Medicare knowledge

Medicaid knowledge

Pharmacy knowledge

Education

High School diploma

Job description

Centene Corporation in the United States is seeking a detail-oriented professional to respond to complaints and escalations from members or providers. This remote role requires strong written and verbal communication, root cause analysis, and the ability to coordinate with multiple departments to resolve issues promptly.

You will document, track, and resolve inquiries, provide timely updates to stakeholders, and help identify trends to improve member experience.