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Centene Corporation Member Relationship Liaison in Clayton, Missouri

ProfessionalPosition Purpose:

  • Utilize multiple systems to investigate escalated inquiries on Members and follow the member experience from beginning to resolution

  • Manage resolution of activities in CRM, including HICS from CMS according to defined turnaround times

  • Collaborate with internal teams and external partners to resolve complaints and document issue and resolution in CRM

  • Conduct member outreach based on a variety of trends such as frequent caller data and out of network claim denials

  • Ensure compliance with State and Federal laws, following State and Federal guidelines as well as the procedures for the plans and the Corporation

  • Recommend workflows and policy as a result of Member feedback and escalation data analysis

  • Work cross functionally with internal departments regarding client needs and requests, work procedures, gaps in policy, and other elements of supporting assigned clients and conduct member, provider and health plan telephonic education as needed

  • Document appropriate client specific information in CRM

  • Ability to travel (10-25%)

Serve as the day-to-day contact for assigned health plans, interacting with Members, Providers and Health Plan Leaders to facilitate problem resolution and promote high client satisfaction

Education/Experience:

Bachelor’s degree in related field or equivalent experience. 2+ years of data management or data analytics experience. Supervisor/lead experience preferred.

Additional Preferred Experience/Skills:

Health insurance operations experience.

Previous experience in a matrix environment working cross functionally.

Experience resolving highly complex customer inquiries in person or over the phone and background in any of the following areas: health insurance operations, administrative responsibilities in a clinical environment or medical office experience.

Self-starter, problem solver, ability to prioritize tasks, and advanced customer service skills.

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: Member Relationship Liaison

LOCATION: Clayton, Missouri

REQNUMBER: 1136738

COMPANY: Health Insurance Operations

POSITION TYPE: Professional

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