Lead Customer Service Representative at Centene in Bedford, NH

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HourlyPosition 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 timesAdvertisement

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