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Lead Customer Service Representative

Centene Corporation Tempe, Arizona

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

“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 1150823

Category Customer Service
Schedule Full-time
Description:

Position Purpose: Serve as a liaison between Customer Service Representatives CSRs), management and other various departments. Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner.

Investigate and resolve complex claims matters in coordination with health plan and/or corporate departments
Coordinate the day-to-day work functions, acting as a “go to” person and investigating and resolving complex issues
Initiate change requests to resolve system configuration questions impacting claims processing; review and test results
Conduct appropriate auditing processes
Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
Educate members and/or providers on health plan initiatives; train and assist providers regarding proper claims billing procedures
Provide first call resolution and “own the process” by working with appropriate internal/external resources and ensure the closure of all inquiries
Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
Identify trends related to member and/or provider inquiries to respond proactively and provide feedback to management
Collaborate 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. Associate’s degree and claims processing, billing and/or coding experience preferred. 2+ years of experience in Medicare, Medicaid managed care or insurance environment preferred. 4+ years of combined customer service and call center experience. Knowledge of managed care software systems (i.e.: OMNI, ABS, CRM, Amisys, TruCare, etc.) preferred. Depending on the state, bi-lingual may 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

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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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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