Escalation Response Specialist II

Centene Corporation•Remote-FL, SC

1d•Hybrid

About The Position

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Requirements

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.
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

Healthcare or health plan experience
Call center, phone based, and call escalation experience
Medicare experience

Responsibilities

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.
Supports the documentation, tracking, and resolution to all assigned complaints and inquiries in writing and/or by telephone in a timely and professional manner.
Supports root cause analysis of member/provider issues to identify trends across the enterprise, and works cross functionally with all departments to ensure enterprise-wide solutions.
Helps to coordinate with contact center team to research underlying facts of escalated inquiries, determine validity of complaints and evaluate options to remedy these complaints.
Reviews complaint trends and uses guidance of senior team members to develop draft recommendations that are designed to enhance member and provider experience and reduce complaints and escalations.
Maintains basic, introductory knowledge of our products and services to provide accurate and effective support to customers.
In some instances, researches and identifies basic claims payment errors and make appropriate adjustments.
Performs other duties as assigned.
Complies with all policies and standards.