Job Description

Position Purpose:

* Take escalated inbound/outbound phone calls on behalf of our Executive Leadership Team for all lines of business while maintaining the highest standard of quality on every call. (Calls are monitored for Quality and Training purposes.)

* Logs, tracks, resolves and responds to all assigned inquires and complaints from members, providers, governing bodies, Regulatory Agencies, Better Business Bureau, Social Media, WellCare Legal Department, Corporate Compliance TRUST Department, Agency for Healthcare Administration (AHCA) and Florida Healthy Kids in writing and/or by telephone, while meeting all regulatory, AHCA and WellCare Corporate guidelines in which special care is required to enhance WellCares relationships; while meeting and exceeding all performance standards.

* Subject Matter Expert in all lines of business.

* Effectively handle/resolve highly escalated issues and represent our CEO in responding to these complaints in a professional manner seeking a win/win for all parties while respecting sound business and health management practices.

* Assist in the education of new members and in the re-education of existing members regarding health plan procedures.

* Thoroughly research and effectively communicate with our members regarding the resolution of their inquiries, complaints and issues with a professional demeanor in a clear, articulate, and timely manner while demonstrating a strong understanding of the issues.

* Work with providers to correct billing and claim issues and educate providers about how to eliminate those problems going forward.

* Act as a liaison between internal departments and external partners on data gathering and problem solving while investigating problems of an unusual nature in the area of responsibility. Present proposed solutions in a clear and concise manner.

* Identify trends and monitor the root cause of member/provider issues and work cross functionally with different departments to ensure enterprise wide solutions.Research and resolve all escalations from members/providers that are addressed to Executive Offices, Executive Leadership Team or the CEO (Presidential) as well as complaints coming from the Attorney General, State officials, and other internal areas for final resolution in a professional, timely, accurate and caring manner. Executive Response Specialist II are part of the Service Escalation Unit (SEU) team who handle the highest level of escalated issues within the organization for all lines of business (Medicare, Medicaid, PDP and Exchange).

Education/Experience:

High school diploma or equivalent. Associates degree preferred. 3+ years in a Healthcare Contact Center or Customer Service environment handling highly escalated complaints experience. Strong oral, written, and problem solving skills.

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.