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Escalation Response Specialist III
| Company | Centene |
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| Location | Florida, USA |
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| Salary | $20 – $34.03 |
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| Type | Full-Time |
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| Degrees | |
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| Experience Level | Junior, Mid Level |
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Requirements
- Requires a High School diploma or GED
- Requires 2 – 4 years of related experience
- May require vocational or technical education in addition to prior work experience
- Experience in healthcare, escalation, and Medicare is highly preferred
Responsibilities
- Responds to complaints and escalations from members or providers
- Handles escalations, handling problem tickets, and providing feedback to leadership regarding member and/or provider issues
- Provides timely and appropriate resolutions to escalated issues received from various communication channels
- Serves as a liaison in maintaining relationships between departments to ensure timely and appropriate issue resolution
- Documents, tracks, resolves, and responds to all assigned complaints and inquiries in writing and/or by telephone in a timely and professional manner
- Conducts and monitors root cause of member or provider issues to identify trends across the enterprise, and works cross functionally with all departments to ensure enterprise-wide solutions
- Coordinates with contact center team to research and review underlying facts of escalated inquiries, determine validity of complaints, and evaluate options to remedy these complaints
- Leverages complaint trends to develop recommendations that are designed to enhance member and provider experience and reduce complaints and escalations
- Provides timely status update reports to members and internal stakeholders to support transparency and improve the customer experience
- Maintains up-to-date knowledge of our products and services to provide accurate and effective support to customers
- In some instances, researches and identifies basic and more complex claims payment errors and make appropriate adjustments to claims
- In some instances, collaborates with the Claims department to price paid claims correctly and/or to send claims to the Claims department for corrections
- In some instances, collaborates with other various business units to resolve claims issues to ensure prompt, accurate claims adjudication
- Performs other duties as assigned
- Complies with all policies and standards
Preferred Qualifications
- Experience in healthcare, escalation, and Medicare is highly preferred
