Complaints and Issues Specialist II

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. Candidate must live in Sacramento or Woodland Hills, CA.

Position Purpose: Documents and addresses customer complaints and issues (I.e., grievances, appeals, Claims Tracking Module) based on regulatory requirements. Supports and collaborates with team members and other functions to document and identify a compliant solution for complaints and issues.

• Processes all received customer inquiries, complaints, and issues using internal tools as defined by the state and federal regulatory requirements.
• Documents written issues and responses related to customer inquiries, complaints, and issues to ensure regulatory compliance.
• Supports the investigation of complaints and issues to determine root cause and identify appropriate resolution.
• Collaborates with internal stakeholders to ensure timely and effective resolution of customer inquiries, complaints, and issues to adhere to quality standards, regulations, and confidentiality.
• Supports the development and implementation of policies and procedures for handling customer inquiries, complaints, and issues.
• Supports in analyzing complaints and issues data to identify trends and opportunities for improvement.
• Runs standard reports for management on the status of customer inquiries, complaints, and issues and to support ad-hoc requests.
• Maintains monthly summary of open cases with to comply with all state and federal regulatory requirements.
• Supports development of materials to train contact center staff on customer inquiries, complaints, and issues resolution and documentation.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience: Requires a High School diploma or GED. Requires 1 – 2 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. Ability to prioritize, perform independent decision making, and manage time effectively preferred. Customer service, grievance and appeals experience in healthcare is highly preferred.  Excellent written and verbal communication skills 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