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

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.

Lead Customer Service Representative - Military Veterans

San Antonio, TX

San Antonio, TX