Customer Service Representative I
Posted on: 9 Jan 2021
Cypress, CA
Job Description
Position Purpose:
Respond to customer inquiries via telephone and written correspondence in a timely and appropriate manner.
* Respond to telephone or written correspondence inquiries from members and/or providers within established timeframes utilizing current reference materials and available resources
* Provide assistance to members and/or providers regarding website registration and navigation
* Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
* Process written customer correspondence and provide the appropriate level of timely follow up
* May coordinate member transportation and make referrals to other departments as appropriate
* Maintain performance and quality standards based on established call center metrics including turn-around times
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* Foundation Care:
* Ensure pharmacy orders and invoices are distributed appropriately to patients and physicians; input patient information into Customer Relationship Management application (CRM) and manage patient billing services
* Research and identify any processing inaccuracies in claim payments and route to the appropriate site operations team for claim adjustment
* Identify any trends related to incoming or outgoing calls that may provide policy or process improvements to support excellent customer service, quality improvement and call reduction
Education/Experience:
High school diploma or equivalent. 1+ years of call center customer service experience, or 2+ years of customer service experience, preferably in a healthcare or insurance environment. Depending on the state, bi-lingual may be preferred.
License/Certification:
For Foundation Care Only: Ability to complete Missouri Registered Pharmacy Tech application on 1st day of hire to obtain non-restricted Missouri Registered Pharmacy Tech within 30 days of hire OR Active Missouri Registered Pharmacy Tech license.
For Nebraska Total Care Only: High school diploma required. . 1+ customer service experience preferred. Customer Service experience in healthcare or insurance industry strongly preferred.
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
