You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Resolve Health Insurance Casework System complaints for the Marketplace line of business.
- Review, investigate, and resolve member inquiries regarding HICS in accordance with internal company guidelines and CMS standards
- Interact with members as needed to interpret HICS complaints and translate complex CMS standards into understandable rules and regulations for members
- Investigate member inquiries using multiple systems to identify and resolve root cause
- Write narratives to CMS and letters to members, in accordance with guidelines and standards, to explain findings and resolutions ensuring concerns are addressed
- Evaluate member feedback, analyze trends, and recommend workflows that may lead to policy or process improvements that support quality and performance standards
- Ensure compliance with State and Federal laws, following State and Federal guidelines as well as the procedures for the plans and the Corporation
- Work on complex cases and projects as needed for case resolution, job enrichment, CMS audit, etc
- Perform a quality review of cases before closing and uploading the case to CMS to ensure case has been fully worked and all systems are updated with correct information contained in narrative and all supporting systems
- Monitor open cases for turnaround times and coordinate with the team on making sure deadlines are being met and staying within standards
Education/Experience: Bachelor's degree in related field or equivalent experience. 2+ year of data management or data analytics experience. Experience within the Medicare, Medicaid, Managed Care or ACA/Commercial Insurance industry is preferred. Member, provider and customer service experience is also preferred.Pay Range: $25.44 - $45.76 per hour
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
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.