Escalation Response Specialist IV

You could be the one who changes everything for our 28 million members as a Customer Care professional at Centene. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.

Applicants for this job have the flexibility to work remote from home anywhere in the Continental United States.

Position Purpose: Responds to non-routine and/or complex complaints and escalations from members or providers and strives to improve customer service. Handles escalations, handling problem tickets, and providing feedback to upper management 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.
• Acts as a primary contact for escalated calls and/or issues in which special care is required to enhance WellCare relationships with members, providers, Centers for Medicare & Medicaid Services (CMS) Caseworkers, State Pharmaceutical Assistance Programs (SPAP), and State Health Insurance Assistance Programs (SHIPs).
• Develops and leads projects and initiatives within the escalation response team to support process improvements.
• Leads efforts with contact center team to research, review underlying facts of escalated inquiry, and determine validity of complaints and evaluate options to remedy these complaints.
• 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.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience: Requires a High School diploma or GED. Requires 4+ years of related experience. May require vocational or technical education in addition to prior work experience. Vocation or technical education may include additional on-the-job training or continuous learning education. Experience as a Supervisor or Lead role is highly preferred.Medicaid, Medicare, HBX ( Market place), Managed Long Term Care ( MLTC) is preferred.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.

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.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act