Remote Escalation Response Specialist III

Centene Corporation; Missouri; Remote; USD 45,000 - 70,000; Full time

Benefits offered by this job

Competitive pay

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off plus holidays

Remote work flexibility

Job summary

Centene Corporation in the United States is seeking a detail-oriented Escalations Specialist to respond to complaints and member or provider escalations. The role supports executive level escalations and requires strong written and verbal communication.

You will work remotely with EST hours (8:00am–5:30pm), coordinating with cross-functional teams, documenting inquiries, and performing root cause analysis to drive enterprise-wide improvements.

Qualifications

• Requires a High School diploma or GED.
• 2–4 years of related experience; vocational or technical education may be required.

Responsibilities

• Provide timely resolutions to escalated issues from members or providers.
• Liaise with departments to ensure timely issue resolution.
• Document and respond to all complaints and inquiries in writing and/or by telephone.
• Conduct root cause analysis to identify trends and implement enterprise-wide solutions.
• Coordinate with contact center to review underlying facts and determine validity of complaints.
• Leverage complaint trends to develop recommendations that improve member and provider experience and reduce escalations.
• Provide timely status updates to members and internal stakeholders to support transparency.
• Maintain knowledge of Centene products and services to provide accurate support to customers.
• Investigate and adjust claims for errors when applicable, and collaborate with Claims for corrections.
• Collaborate with other business units to resolve claims issues and ensure prompt adjudication.
• Performs other duties as assigned.

Skills

Root cause analysis

Complaint resolution

Communication skills

Cross-functional collaboration

Medicare/Medicaid/Pharmacy knowledge

Education

High School diploma or GED

Vocational or technical education

Job description

Centene Corporation in the United States is seeking a detail-oriented Escalations Specialist to respond to complaints and member or provider escalations. The role supports executive level escalations and requires strong written and verbal communication.

You will work remotely with EST hours (8:00am–5:30pm), coordinating with cross-functional teams, documenting inquiries, and performing root cause analysis to drive enterprise-wide improvements.