SilverSummit Healthplan: Lead Customer Service Representative

You could be the one who changes everything for our 25 million members.

Centene is transforming the health of our communities, one person at a time.

As a diversified, multi-national organization, youll have access to competitive benefits including a fresh perspective on workplace flexibility.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 departmentsCoordinate the day-to-day work functions, acting as a go to person and investigating and resolving complex issuesInitiate change requests to resolve system configuration questions impacting claims processing; review and test resultsConduct appropriate auditing processesReference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status mattersEducate members and/or providers on health plan initiatives; train and assist providers regarding proper claims billing proceduresProvide first call resolution and own the process by working with appropriate internal/external resources and ensure the closure of all inquiriesDocument all activities for quality and metrics reporting through the Customer Relationship Management (CRM) applicationIdentify trends related to member and/or provider inquiries to respond proactively and provide feedback to managementCollaborate with other departments on cross functional tasks and projects Maintain performance and quality standards based on established call center metrics including turn-around timesOur Comprehensive Benefits Package:Flexible work solutions including remote options, hybrid work schedules and dress flexibilityCompetitive payPaid Time Off including paid holidaysHealth insurance coverage for you and dependents401(k) and stock purchase plansTuition reimbursement and best-in-class training and developmentEducation/Experience: High school diploma or equivalent.

Associates 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.