Customer Service Representative II (HNGSS)
Posted on: 1 Jan 2021
Johnstown, PA
Job Description
Position Purpose:
This is the advanced level of Customer Service Representative, responsible for handling customer service questions and issues. Associates at this level handle escalated issues that require greater product and service knowledge, and a higher level of customer service skill. The Customer Service Representative takes calls and processes transactions, such as referrals, authorizations, etc. The Customer Service Representative also resolves urgent and high profile problems from Beneficiary Counseling and Assistance Coordinators.
* Researches and responds to inquiries from beneficiaries and providers, such as benefits, claims, eligibility concerns, authorizations, etc.
* Handles escalated and high priority customer service issues.
* Resolves/de-escalates and/or escalates issues. Follows through with each issue to resolution by working with internal and external resources as needed.
* Receives calls for referrals and authorizations transactions, reviews documents, and modifies authorizations/referrals as prescribed by written procedures. Documents transactions in appropriate medical management systems.
* Receives urgent/important/high profile calls from Beneficiary Counseling and Assistance Coordinators (BCAC). Works with all available resources to resolve issues quickly and within customers expectations, confirms solutions with BCAC, tracks calls and solutions, and balances business decisions with customer needs.
* Processes additional assignments, such as PCM changes, address changes, ID card replacements, RAOC status calls and data entry, and updates provider demographics/files, etc.
* Writes responses to inquiries.
* Collects and tracks data regarding escalations so trends and issues can be identified or analyzed.
* Assists in training other Customer Service Representatives.
* Demonstrates regular, reliable and predictable attendance.
* Other duties as assigned.
Education/Experience:
High School diploma or GED.
Minimum two years high-volume customer service experience in a demanding environment, preferably in a healthcare related industry; 1 year or more as a CSR I.
This position will be supporting a Federal government contract, therefore it requires U. S. citizenship and proof of favorable adjudication following submission of Department of Defense form SF86 or higher security.
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.
Centene
St Louis, MO
Centene Corporation operates as a diversified and multi-national healthcare enterprise that provides programs and services to under-insured and uninsured individuals in the United States. The company’s Managed Care segment offers health plan coverage to individuals through government subsidized programs, including Medicaid, the State children’s health insurance program, long-term services and support, foster care, and medicare-medicaid plans, which covers dually eligible individuals, as well as aged, blind, or disabled programs. Its health plans include primary and specialty physician care, inpatient and outpatient hospital care, emergency and urgent care, prenatal care, laboratory and X-ray, home-based primary care, transportation assistance, vision care, dental care, telehealth, immunization, specialty pharmacy, therapy, social work, nurse advisory, and care coordination services, as well as prescriptions, limited over-the-counter drugs, medical equipment, and behavioral health and abuse services.
This segment also offers various individual, small group, and large group commercial healthcare products to employers and directly to members in the Managed Care segment.Its Specialty Services segment provides pharmacy benefits management services; health, triage, wellness, and disease management services; and vision and dental, and management services, as well as care management software that automate the clinical, administrative, and technical components of care management programs. This segment offers its services and products to state programs, correctional facilities, healthcare organizations, employer groups, and other commercial organizations. The company provides its services through primary and specialty care physicians, hospitals, and ancillary providers. Centene Corporation was founded in 1984 and is headquartered in St. Louis, Missouri.
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IndustryHealthcare
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No. of Employees47, 300
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Website
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Jobs Posted349
