Complaints and Issues Specialist II

Centene Corporation

14h•$18 - $28

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. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Position Purpose: Documents and addresses customer complaints and issues (I.e., grievances, appeals, Claims Tracking Module) based on regulatory requirements. Supports and collaborates with team members and other functions to document and identify a compliant solution for complaints and issues. Processes all received customer inquiries, complaints, and issues using internal tools as defined by the state and federal regulatory requirements Documents written issues and responses related to customer inquiries, complaints, and issues to ensure regulatory compliance Supports the investigation of complaints and issues to determine root cause and identify appropriate resolution Collaborates with internal stakeholders to ensure timely and effective resolution of customer inquiries, complaints, and issues to adhere to quality standards, regulations, and confidentiality Supports the development and implementation of policies and procedures for handling customer inquiries, complaints, and issues Supports in analyzing complaints and issues data to identify trends and opportunities for improvement Runs standard reports for management on the status of customer inquiries, complaints, and issues and to support ad-hoc requests Maintains monthly summary of open cases with to comply with all state and federal regulatory requirements Supports development of materials to train contact center staff on customer inquiries, complaints, and issues resolution and documentation Performs other duties as assigned Complies with all policies and standards

Requirements

Requires a High School diploma or GED.
Requires 1 – 2 years of related experience.
May require vocational or technical education in addition to prior work experience.

Nice To Haves

Ability to prioritize, perform independent decision making, and manage time effectively preferred.
Experience with Medicare complaints, grievance and being detailed oriented is highly preferred.

Responsibilities

Documents and addresses customer complaints and issues (I.e., grievances, appeals, Claims Tracking Module) based on regulatory requirements.
Supports and collaborates with team members and other functions to document and identify a compliant solution for complaints and issues.
Processes all received customer inquiries, complaints, and issues using internal tools as defined by the state and federal regulatory requirements
Documents written issues and responses related to customer inquiries, complaints, and issues to ensure regulatory compliance
Supports the investigation of complaints and issues to determine root cause and identify appropriate resolution
Collaborates with internal stakeholders to ensure timely and effective resolution of customer inquiries, complaints, and issues to adhere to quality standards, regulations, and confidentiality
Supports the development and implementation of policies and procedures for handling customer inquiries, complaints, and issues
Supports in analyzing complaints and issues data to identify trends and opportunities for improvement
Runs standard reports for management on the status of customer inquiries, complaints, and issues and to support ad-hoc requests
Maintains monthly summary of open cases with to comply with all state and federal regulatory requirements
Supports development of materials to train contact center staff on customer inquiries, complaints, and issues resolution and documentation
Performs other duties as assigned
Complies with all policies and standards