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Centene Corporation Customer Service Representative II (HNGSS) in Johnstown, Pennsylvania


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 Coordinators.

  • 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 management systems.

  • 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.

TITLE: Customer Service Representative II (HNGSS)

LOCATION: Johnstown, Pennsylvania

REQNUMBER: 1191047

COMPANY: Customer Service