Member Relationship Liaison

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
 

Position Purpose: 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.

• Utilize multiple systems to investigate escalated inquiries on Members/Providers and follow the Member/Provider 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/Provider 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/Provider 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.
• Performs other duties as assigned.
• Complies with all policies and standards.

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