Medicare Escalation Specialist I

You could be the one who changes everything for our 26 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.Position Purpose: Responds to member, provider, CMS, SPAP and SHIP inquiries received via phone, CTM (Complaint Tracking Module) and email regarding PDP, CCP and Medicaid lines of business, including Claims, CIU, Enrollment, Pharmacy, Billing, Case Management, and Appeals in a professional, timely, accurate and caring manner- while consistently meeting all CMS guidelines and requirements. Instrumental in providing suggestions to reduce complaints and increase WellCare's Star Ratings.· Handle and resolve CTM complaints, SHIP escalated issues, and GCR requests received via HPMS CTM, email, mail correspondence, and inbound/outboundphone calls· Logs, tracks, resolves and responds to all assigned complaints and inquires in writing and/or by telephone in a timely and professional manner to members, providers, CMS, SPAP/SHIP· Assist in the education of new members and in the re-education of existing members regarding health plan procedures· Communicate research and resolution to CMS, SPAP/SHIP representatives, and stakeholders· Act as a liaison between internal departments and external partners on data gathering and problem solving by investigating and present proposed solutions in a clear and concise manner· Identify trends, monitor the root cause of member/provider issues, and work cross functionally with all departments to ensure enterprise wide solutions· Efficiently and effectively, maintain a high caseload while meeting and exceeding all performance standardsEducation/Experience:

High school diploma or equivalent. 1+ years in a Healthcare Contact Center or Customer Service environment handling highly escalated complaints experience. Strong oral, written, and problem solving skills.Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.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: Medicare Escalation Specialist ILOCATION: Various, FloridaREQNUMBER: 1373048