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Referral Specialist I

Health Net of California Woodland Hills, California, Sacramento, California

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 1122806
Additional Locations Sacramento,California,US
Category Customer Service
Schedule Full-time
Description:
Position Purpose: Assist in monitoring utilization of medical services to assure cost effective use of medical resources through processing prior authorizations.

  • Initiate authorization requests for outpatient and inpatient services in accordance with the prior authorization list. Route to appropriate staff when needed.
  • Verify eligibility and benefits
  • Answer phone queues and process faxes within established standards
  • Data enters authorizations into the system.
  • Qualifications:

    Education/Experience: High school diploma or equivalent. 2+ years of customer service experience. Knowledge of medical terminology 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.

    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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    • Customer Service, Woodland Hills, California, United StatesRemove
    • Customer Service, Sacramento, California, United StatesRemove

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