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Customer Service Representative I

Buckeye Community Health Plan Columbus, Ohio

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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Our Customer Service Roles

Customer Care Opportunities at Centene

Our Customer Service teams work to ensure high levels of service and customer satisfaction. Learn more about this vital group at Centene

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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Responsibilities

Job ID 1167082

Category Customer Service
Schedule Full-time
Description:

Position Purpose: Respond to customer inquiries via telephone and written correspondence in a timely and appropriate manner.

  • Respond to telephone or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources
  • Provide assistance to members and/or providers regarding website registration and navigation
  • 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 timely follow up
  • May coordinate member transportation and make referrals to other departments as appropriate
  • Maintain performance and quality standards based on established call center metrics including turn-around times

    Foundation Care:
    Ensure pharmacy orders and invoices are distributed appropriately to patients and physicians; input patient information into Customer Relationship Management application (CRM) and manage patient billing services
  • Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment
  • Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service, quality improvement and call reduction

  • Qualifications:


    Education/Experience: High school diploma or equivalent. 1+ years of call center customer service experience, or 2+ years of customer service experience, preferably in a healthcare or insurance environment. Depending on the state, bi-lingual may be preferred.

    License/Certification:

    For Foundation Care Only: Ability to complete Missouri Registered Pharmacy Tech application on 1st day of hire to obtain non-restricted Missouri Registered Pharmacy Tech within 30 days of hire OR Active Missouri Registered Pharmacy Tech license.

    For Nebraska Total Care Only: High school diploma required. . 1+ customer service experience preferred. Customer Service experience in healthcare or insurance industry strongly 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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    Quote

    “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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    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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