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Customer Service Representative II

Home State Health Plan Chesterfield, Missouri

As part of the Customer Service department, you’ll use your knowledge of Centene’s insurance products and service to help our members understand their benefits, details and policy procedures. With your skills, you can help transform the health of every community, one person at a time.

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What does it take?

What are the qualities that will help you achieve success in this role at Centene?

Success Profile

  • Detail-oriented
  • Organized
  • Proactive
  • Positive
  • Trustworthy
  • Consistent

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Quote

“I enjoy knowing that by doing my job efficiently, our providers can focus on giving the best care to the members we serve.”

- Kim Joyce, Claims Analyst

“Centene has been instrumental in my professional development. I’m pushed in a way that challenges my fears, improve my skills, and enhance my knowledge on healthcare.”

- Meaghan Hooks, Business Analyst II

“My job has a direct impact on our providers and members. With every claim paid out the door we are directly helping to save someone’s life!”

- Jonelle Levy, Business Analyst II

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Responsibilities

Job ID 1123808

Category Customer Service
Schedule Full-time
Description:
Position Purpose: Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner

  • Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
  • Provide assistance to members and/or providers regarding website registration and navigation
  • Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources, and ensure closure of all inquiries
  • Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
  • Process written customer correspondence and provide the appropriate level of follow-up in a timely manner
  • Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustment
  • Identify trends related to member and/or provider inquiries that may lead to policy or process improvements that support excellent customer service and impact quality and performance standards
  • Work with other departments on cross functional tasks and projects
  • Maintain performance and quality standards based on established call center metrics including turn-around times
  • Qualifications:

    Education/Experience: High school diploma or equivalent. Associates degree and claims processing, billing and/or coding experience preferred. 1+years of experience in Medicare, Medicaid managed care or insurance environment preferred. 2+ years of combined customer service experience a and call center environment. Knowledge of managed care programs and services preferred. Depending on the state, bi-lingual skills may also be preferred.

    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.
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    Our Customer Service Roles

    Claims Analyst

    As part of a tight-knit team and working as a partner to each provider, you’ll evaluate the needs of your health plan and process all claims in accordance with guidelines.

    Claims Liaisons

    While ensuring that provider and member requests are taken care of, you’ll review requests from providers and work with state health plans to ensure the accuracy and quality of claims.

    Customer Service Representative

    You’ll use your healthcare knowledge, analytical skills and our information resources to quickly and correctly answer questions from members and providers.

    Enrollment Analyst

    You’ll process incoming membership files and focus on maintaining the enrollment integrity of our individual health plan systems.

    Systems Solutions Manager

    While leading a team of business analysts, you’ll work with the IT department to drive end-to-end solutions for core applications supporting Centene’s operations. Claims Analyst.

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    Our Awards

    Centene is consistently recognized for how well we treat our members, our people, and the communities we serve.

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    Our Hiring Process

    Learn more about our hiring process and discover other helpful information for applicants.

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    “Centene is an exciting company to work for.”

    Esmeralda Baig

    Started as a Case Manager, now a Senior Vice President of Operation

    See Esmeralda's career path

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    • Customer Service, Chesterfield, Missouri, United StatesRemove

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