Claims Escalation Response Specialist IV
This job is no longer available
There are still lots of open positions. Let's find the one that's right for you.
About The Position
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.
