Centene Corporation jobs

Application Software Developer (Intranet) – Military Veterans

MILITARY VETERANS Position Purpose: Design, build, test and maintain scalable and stable off the shelf application or custom built technology solutions to meet business needsParticipate and contribute in the entire implementation process for new applications and enhancements to existing applications Provide input on the overall solution design Build and test applications Meet with business partners to understand business needs Conduct root cause analysis and implement basic performance t...

Care Manager II (CA) – Military Veterans

MILITARY VETERANS Position Purpose: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care.· Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options· Utilize assessment skills and discretionary judgment to develop plan of care ba...

Account Coordinator – Military Veterans

MILITARY VETERANS Position Purpose: Serve as customer support for client accounts ensuring the highest level of customer satisfaction Collaborate with Account Management team, serve as the initial point of contact for issue resolution, and escalate inquiries to respective business groups as needed Assist with account planning and support strategies of clients Assist in identifying and solving customer needs, issues and inquiries Maintain and provide reports to identify data and trends Par...

Commissions Analyst I – Military Veterans

MILITARY VETERANS Position Purpose: The Commissions Analyst I is responsible for processing of all commission related payments, accounting entries and reports for the broker network. Performs data reconciliation, research commission related payment and provides assistance to other team members on new accounts, difficult issues, and processes and procedures. Prepares scheduled and month-end reports, and provides analytical support by identifying issues with commission payments. Reviews report...

Account Manager – Military Veterans

MILITARY VETERANS Position Purpose: Manage and maintain assigned account and client relationships and service responsibilities, including implementations, relationship building, monitoring contract compliance, and ensuring performance guarantees and general customer service to all accounts. Manage and maintain assigned account and client relationships and service responsibilities Assist in the project management of all contract implementations and in the establishment of strong account relat...

Supervisor, Grievance & Appeals – Military Veterans

MILITARY VETERANS Position Purpose: Ensure that the Appeals & Grievance department processes all appeals, grievances and complaints in accordance with standards and the corporation’s policies and procedures Serve as a resource to the team regarding escalated or complex issues, process and systems issues, and regulatory updates Monitor and distribute team’s case load and ensure adequate coverage Monitor and evaluate performance standards and provide daily feedback and guidance of probl...

Eligibility Representative I – Military Veterans

MILITARY VETERANS Position Purpose: Processes and maintains eligibility information for routine individual and/or employer groups under direct supervision. Maintains accurate eligibility records for assigned line of business. Enters system eligibility data on a daily basis, including new enrollees, changes, and cancellations. Conducts periodic audits of group eligibility data. Reconciles group eligibility report to monthly statements. Responds to all written and telephone eligibility inqu...

Member Relationship Liaison – Military Veterans

MILITARY VETERANS Position 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 clai...

Grievance & Appeals Coordinator I – Military Veterans

MILITARY VETERANS Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.Gather, analyze and report verbal and written member and provider complaints, grievances and appeals Prepare response letters for member and provider complaints, grievances and appeals Maintain files on individual appeals and grievances May coordinate the Grievance and Appeals Committee Support the pay-for-performanc...

Eligibility Representative I – Military Veterans

MILITARY VETERANS Position Purpose: Processes and maintains eligibility information for routine individual and/or employer groups under direct supervision. Maintains accurate eligibility records for assigned line of business. Enters system eligibility data on a daily basis, including new enrollees, changes, and cancellations. Conducts periodic audits of group eligibility data. Reconciles group eligibility report to monthly statements. Responds to all written and telephone eligibility inqu...
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