Remote Escalation Response Specialist III

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

Benefits offered by this job

Health insurance

401K and stock purchase plans

Tuition reimbursement

Paid time off + holidays

Remote work flexibility

Job summary

Centene Corporation is seeking a qualified professional to respond to complaints and escalations from members or providers, handling problem tickets and providing feedback to leadership. This is a remote role with hours 8:00am–5:30pm EST, Monday–Friday.

Strong communication, root cause analysis, and knowledge of Medicare, Medicaid, Pharmacy are preferred. The position supports executive level member escalations and requires effective written and verbal communication, with a focus on timely

Qualifications

• Requires a High School diploma or GED.
• Requires 2 - 4 years of related experience.
• Vocation 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

Strong written and verbalcommunication

Root cause analysis

Customer service orientation

Education

High School diploma or GED

Job description

Centene Corporation is seeking a qualified professional to respond to complaints and escalations from members or providers, handling problem tickets and providing feedback to leadership. This is a remote role with hours 8:00am–5:30pm EST, Monday–Friday.

Strong communication, root cause analysis, and knowledge of Medicare, Medicaid, Pharmacy are preferred. The position supports executive level member escalations and requires effective written and verbal communication, with a focus on timely