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Customer Service Representative II (HNGSS)

Federal Services Johnstown, Pennsylvania

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 1153730

Category Customer Service
Schedule Full-time
Description:

Position Purpose: This is the advanced level of Customer Service Representative, responsible for handling customer service questions and issues. Associates at this level handle escalated issues that require greater product and service knowledge, and a higher level of customer service skill. The Customer Service Representative takes calls and processes transactions, such as referrals, authorizations, etc. The Customer Service Representative also resolves urgent and high profile problems from Beneficiary Counseling and Assistance Coordinators.

Researches and responds to inquiries from beneficiaries and providers, such as benefits, claims, eligibility concerns, authorizations, etc.
Handles escalated and high priority customer service issues.
Resolves/de-escalates and/or escalates issues. Follows through with each issue to resolution by working with internal and external resources as needed.
Receives calls for referrals and authorizations transactions, reviews documents, and modifies authorizations/referrals as prescribed by written procedures. Documents transactions in appropriate medical management systems.
Receives urgent/important/high profile calls from Beneficiary Counseling and Assistance Coordinators (BCAC). Works with all available resources to resolve issues quickly and within customers’ expectations, confirms solutions with BCAC, tracks calls and solutions, and balances business decisions with customer needs.
Processes additional assignments, such as PCM changes, address changes, ID card replacements, RAOC status calls and data entry, and updates provider demographics/files, etc.
Writes responses to inquiries.
Collects and tracks data regarding escalations so trends and issues can be identified or analyzed.
Assists in training other Customer Service Representatives.
Demonstrates regular, reliable and predictable attendance.
Other duties as assigned.

Qualifications:


Education/Experience: High School diploma or GED.
Minimum two years high-volume customer service experience in a demanding environment, preferably in a healthcare related industry; 1 year or more as a CSR I.
This position will be supporting a Federal government contract, therefore it requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security.

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.

Honored to be Honored

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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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