Lead Customer Service Representative
Company: Home State Health Plan
Posted on: June 22, 2022
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
- 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
- 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)
- 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
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.
Keywords: Home State Health Plan, Independence , Lead Customer Service Representative, Sales , Independence, Missouri
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