Lead Customer Service Representative - Remote in Pennsylvania

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Posted 9 days ago United States Salary undisclosed
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Job Description

You could be the one who changes everything for our 25 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, multi-national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Serve as a liaison between Customer Service Representatives CSRs), management and other various departments. Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner.
  • Investigate and resolve complex claims matters in coordination with health plan and/or corporate departments
  • Coordinate the day-to-day work functions, acting as a "go to" person and investigating and resolving complex issues
  • Initiate change requests to resolve system configuration questions impacting claims processing; review and test results
  • Conduct appropriate auditing processes
  • Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
  • Educate members and/or providers on health plan initiatives; train and assist providers regarding proper claims billing procedures
  • Provide first call resolution and "own the process" by working with appropriate internal/external resources and ensure the closure of all inquiries
  • 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
  • Collaborate with other departments on cross functional tasks and projects Maintain performance and quality standards based on established call center metrics including turn-around times

Our Comprehensive Benefits Package:
  • Flexible work solutions including remote options, hybrid work schedules and dress flexibility
  • Competitive pay
  • Paid Time Off including paid holidays
  • Health insurance coverage for you and dependents
  • 401(k) and stock purchase plans
  • Tuition reimbursement and best-in-class training and development


Education/Experience: High school diploma or equivalent. Associates' degree or equivalent 2 years higher education and/or work experience in Claims processing, billing, or coding experience preferred. 1.5+ years' experience as a Customer Service Representative or previous Call Center, Healthcare or insurance experience. Expert in understanding the working of a call center environment. Expert in customer service, verbal communication over the phone. 2+ years of experience in Medicare, Medicaid managed care or insurance environment 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.