Senior Customer Service Representative

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Senior Customer Service Representative


Position Purpose: Resolve customer inquiries via telephone and written

correspondence in a timely and appropriate manner.

Using current reference materials, answer inquiries from members

and/or providers regarding claims, eligibility, covered benefits,

authorizations and pharmacy related matters

Provide assistance to members and/or providers regarding website

registration and navigation

Educate members and/or providers on health plan initiatives during

telephone conversations

Provide first call resolution; working with appropriate

internal/external resources, completing necessary follow-up, and

ensuring closure of the inquiry

Document all activities for quality and metrics reporting through the

Customer Relationship Management (CRM) application

Identify trends related to member and/or provider inquiries to respond

proactively and provide feedback to management

Process and follow through on all matters related to Provider

Addition, Change and Termination (PACT) forms, Customer Service Forms

(CSFs), and claims projects in a timely manner. Conduct appropriate

auditing processes

Process forms required to release pending claims to providers

Work with other departments on cross functional tasks and projects

Maintain performance and quality standards based on established call

center metrics including turn-around times

Education/Experience: High school diploma or equivalent. 3+ years of

combined call center and customer service experience preferably in a

healthcare or insurance environment. 1+ years of managed care

experience preferred. Associate s degree and claims processing,

billing and/or coding experience preferred. Depending on the state,

bi-lingual skills may also be preferred. Proficient typist preferred.

Working knowledge of all Microsoft products and working with multiple

programs and screens preferred. Experience with performance metrics

(ASA, service levels, productivity, abandonment rate, talk time)


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.

  • 1
  • Negotiable
  • None
  • None
  • Re-119935
  • Permanent
  • 1

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