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Customer Service Representative II, Nashville, Tennessee

Created10/17/2020
Reference1203371
CategoryCustomer Service
Job typeFull-Time
CountryUnited States of America
StateTennessee
CityNashville
Zip37201
SalaryCompetitive
Position Purpose: Resolve customer inquiries via telephone and written correspondence in a timely and appropriate manner

  • Reference current materials to answer escalated and complex inquiries from members and providers regarding claims, eligibility, covered benefits and authorization status matters
  • Provide assistance to members and/or providers regarding website registration and navigation
  • Educate members and/or providers on health plan initiatives Provide first call resolution working with appropriate internal/external resources, and ensure closure of all inquiries
  • Document all activities for quality and metrics reporting through the Customer Relationship Management (CRM) application
  • Process written customer correspondence and provide the appropriate level of follow-up in a timely manner
  • Research and identify processing inaccuracies in claim payments and route to the appropriate team for claim adjustment
  • Identify trends related to member and/or provider inquiries that may lead to policy or process improvements that support excellent customer service and impact quality and performance standards
  • Work with other departments on cross functional tasks and projects
  • Maintain performance and quality standards based on established call center metrics including turn-around times



  • Qualifications:

    Education/Experience:

    • High school diploma or equivalent and 2+ years of customer service experience in a call center environment
    • Associates degree and claims processing, billing and/or coding experience preferred
    • 1+years of experience in Medicare, Medicaid managed care or insurance environment preferred
    • Knowledge of managed care programs and services preferred
    • Depending on the state, bi-lingual skills may also be 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.
    EmployerCentene Corporation

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