Remote Escalation Response Lead for Exec Support

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

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Remote work option

Job summary

Centene Corporation is seeking a remote Escalations Specialist to respond to complaints from members and providers, handle problem tickets, and provide feedback to leadership. The role operates 8:00am–5:30pm EST, Monday–Friday, and supports executive level member escalations.

The position requires 2–4 years of related experience, strong communication, and root cause analysis skills. Knowledge of Medicare, Medicaid, and Pharmacy is preferred, with a focus on enterprise-wide issue resolution.

Qualifications

• Requires 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

Root cause analysis

Strong written and verbal коммуника

Education

High School diploma or GED

Job description

Centene Corporation is seeking a remote Escalations Specialist to respond to complaints from members and providers, handle problem tickets, and provide feedback to leadership. The role operates 8:00am–5:30pm EST, Monday–Friday, and supports executive level member escalations.

The position requires 2–4 years of related experience, strong communication, and root cause analysis skills. Knowledge of Medicare, Medicaid, and Pharmacy is preferred, with a focus on enterprise-wide issue resolution.