Claims Escalation Response Specialist IV

You could be the one who changes everything for our 28 million members as a Customer Care professional at Centene. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: Responds to non-routine and/or complex complaints and escalations from members or providers and strives to improve customer service. Handles escalations, handling problem tickets, and providing feedback to upper management regarding member and/or provider issues.

• Provides timely and appropriate resolutions to escalated issues received from various communication channels
• Serves as a liaison in maintaining relationships between departments to ensure timely and appropriate issue resolution
• Documents, tracks, resolves, and responds to all assigned complaints and inquiries in writing and/or by telephone in a timely and professional manner
• Conducts and monitors root cause of member or provider issues to identify trends across the enterprise, and works cross functionally with all departments to ensure enterprise-wide solutions
• Acts as a primary contact for escalated calls and/or issues in which special care is required to enhance WellCare relationships with members, providers, Centers for Medicare & Medicaid Services (CMS) Caseworkers, State Pharmaceutical Assistance Programs (SPAP), and State Health Insurance Assistance Programs (SHIPs)
• Develops and leads projects and initiatives within the escalation response team to support process improvements
• Leads efforts with contact center team to research, review underlying facts of escalated inquiry, and determine validity of complaints and evaluate options to remedy these complaints
• Provides timely status update reports to members and internal stakeholders to support transparency and improve the customer experience
• Maintains up-to-date knowledge of our products and services to provide accurate and effective support to customers
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Requires a High School diploma or GED. Requires 4+ years of related experience. May require vocational or technical education in addition to prior work experience. Vocation or technical education may include additional on-the-job training or continuous learning education. Strong claims background is highly preferred.

Pay Range: $22.50 - $38.02 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 …