Customer Service Representative II (HNGSS)
Position Purpose: This is the advanced level of Customer Service
Representative, responsible for handling customer service questions
and issues. Associates at this level handle escalated issues that
require greater product and service knowledge, and a higher level of
customer service skill. The Customer Service Representative takes
calls and processes transactions, such as referrals, authorizations,
etc. The Customer Service Representative also resolves urgent and high
profile problems from Beneficiary Counseling and Assistance
Researches and responds to inquiries from beneficiaries and providers,
such as benefits, claims, eligibility concerns, authorizations, etc.
Handles escalated and high priority customer service issues.
Resolves/de-escalates and/or escalates issues. Follows through with
each issue to resolution by working with internal and external
resources as needed.
Receives calls for referrals and authorizations transactions, reviews
documents, and modifies authorizations/referrals as prescribed by
written procedures. Documents transactions in appropriate medical
Receives urgent/important/high profile calls from Beneficiary
Counseling and Assistance Coordinators (BCAC). Works with all
available resources to resolve issues quickly and within customers
expectations, confirms solutions with BCAC, tracks calls and
solutions, and balances business decisions with customer needs.
Processes additional assignments, such as PCM changes, address
changes, ID card replacements, RAOC status calls and data entry, and
updates provider demographics/files, etc.
Writes responses to inquiries.
Collects and tracks data regarding escalations so trends and issues
can be identified or analyzed.
Assists in training other Customer Service Representatives.
Demonstrates regular, reliable and predictable attendance.
Other duties as assigned.
Education/Experience: High School diploma or GED.
Minimum two years high-volume customer service experience in a
demanding environment, preferably in a healthcare related industry; 1
year or more as a CSR I.
This position will be supporting a Federal government contract,
therefore it requires U. S. citizenship and proof of favorable
adjudication following submission of Department of Defense form SF86
or higher security.
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.
Location/Region: Rancho Cordova, CA