Escalation Response Specialist III

Position Purpose: Responds to complaints and escalations from members or providers. Handles escalations, handling problem tickets, and providing feedback to leadership regarding member and/or provider issues.

Key Details: Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J -1, OPT, or CPT.

This is a remote position and the hours are between 8:00am and 5:30pm EST, Monday – Friday. This position supports executive level member escalations. Strong written and verbal communication skills, root cause analysis experience, and knowledge of Medicare, Medicaid, Pharmacy is preferred.

• Provides timely and appropriate resolutions to escalated issues received from various communication channels
• Serves as a liaison in maintaining relationships between departments to ensure timely and appropriate issue resolution
• Documents, tracks, resolves, and responds to all assigned complaints and inquiries in writing and/or by telephone in a timely and professional manner
• Conducts and monitors root cause of member or provider issues to identify trends across the enterprise, and works cross functionally with all departments to ensure enterprise-wide solutions
• Coordinates with contact center team to research and review underlying facts of escalated inquiries, determine validity of complaints, and evaluate options to remedy these complaints
• Leverages complaint trends to develop recommendations that are designed to enhance member and provider experience and reduce complaints and escalations
• Provides timely status update reports to members and internal stakeholders to support transparency and improve the customer experience
• Maintains up-to-date knowledge of our products and services to provide accurate and effective support to customers
• In some instances, researches and identifies basic and more complex claims payment errors and make appropriate adjustments to claims
• In some instances, collaborates with the Claims department to price paid claims correctly and/or to send claims to the Claims department for corrections
• In some instances, collaborates with other various business units to resolve claims issues to ensure prompt, accurate claims adjudication
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience: Requires a High School diploma or GED.
Requires 2 - 4 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.

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

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, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

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