• Receiving, investigating and resolving all customer inquiries timely and accurately. • Handling customer service inquiries and problems via the telephone. • Ensuring all customer communication is clearly documented. • Interact through various channels such as Chat, Phone, E-mail and TEAMS. • Educating caller to ensure resolution is achieved on first contact.

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. *Qualified candidates for this role must be able to work 8:30AM-5:00PM EST Monday-Friday* 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. Position Purpose: The Pharmacy Resolution Specialist receives and responds to calls from members, provider/physician's offices, and pharmacies. This role makes outbound calls and enters pharmacy overrides into systems based on approved guidelines and approvals provided from clinical pharmacists. - Takes member/prescriber/pharmacist inquiry calls for benefit questions including prior authorization requests - Offers options including submission of a prior authorization request - Thoroughly researches issues and takes appropriate action to resolve them using the appropriate reference material within turnaround time requirements and quality standards - Logs, tracks, resolves, and responds to all assigned inquiries and complaints while meeting all regulatory, CMS, and Centene Corporate guidelines in which special care is required to enhance Centene relationships, while meeting and exceeding all performance standards - Maintains expert knowledge on all pharmacy benefits and formularies, including CMS regulations as they pertain to this position - Responsible for knowing and interpreting pharmacy and medical benefits - Answers and conducts inbound and outbound calls with members and provider offices to provide resolution to claims (i.e.: additional information requests and medication determination updates) - Actively involved in the initiation and providing status for prior authorization/coverage determination, appeal / redetermination phone calls - Responsible for ensuring outstanding attention to detail - Identify root cause issues to ensure enterprise solutions and communicate findings as needed to ensure first call resolution - Assists with special projects as assigned - Performs other duties as assigned - Complies with all policies and standards Education/Experience: High School Diploma / GED and 1 year of Job Specific call center/customer service. Pay Range: $15.87 - $27.25 per hour 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

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. 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 position is remote and starting hours for this position are between 8:00am and 10:30am EST, Monday - Friday. Experience with Medicare, Medicaid, and prescription drug plans is preferred. Position Purpose: Assists with responding to complaints and escalations from members/providers. Supports in handling escalations, handling problem tickets, and providing feedback to senior team members regarding member/provider issues. - 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 - Supports the documentation, tracking, and resolution to all assigned complaints and inquiries in writing and/or by telephone in a timely and professional manner - Supports root cause analysis of member/provider issues to identify trends across the enterprise, and works cross functionally with all departments to ensure enterprise-wide solutions - Helps to coordinate with contact center team to research underlying facts of escalated inquiries, determine validity of complaints and evaluate options to remedy these complaints - Reviews complaint trends and uses guidance of senior team members to develop draft recommendations that are designed to enhance member and provider experience and reduce complaints and escalations - Maintains basic, introductory knowledge of our products and services to provide accurate and effective support to customers - In some instances, researches and identifies basic claims payment errors and make appropriate adjustments - 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. Pay Range: $17.84 - $28.02 per hour 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

Customer Service Rep – Behavioral Health – Evernorth Workplace Care Evernorth Workplace Care offers health care delivery services along with population health and health coaching solutions. Our mission is to deliver proactive, personalized, and holistic patient care and coaching by acting on health data and insights to improve the overall health and wellness of our clients’ employees, and those they care about most, by providing access to high quality, affordable services where they work and live. Evernorth Workplace Care - Personalized Care Where You Are The experienced Customer Service Rep provides critical service to key business associates, providing the utmost customer-focused assistance, and is a vital partner on our team. This position will be responsible for Scheduling, registration paperwork, phone and email correspondence with patients, as well as additional tasks to support the Behavioral Health Program. Responsibilities: - Telephonic appointment scheduling and outreach calls in support of the EWC Behavioral Health program. - Oversight of email inboxes for Behavioral health locations - Independently responds to inquiries from customers for information and assistance of moderate and substantial complexity. - Scheduling patient appointments - Registration paperwork through mychart - Using Electronic Health Record - Epic – monitor for self-scheduled appts; confirm completion of registration / insurance - Answer calls / Outbound Confirmation and No-Show calls - Outreach to patients if clinician is out to reschedule appts - Email correspondence with patients – sending collateral following presentations - Additional tasks as needed to support the Behavioral health program Qualifications for this role are: - At least a High School Diploma or equivalent required. - Strong oral and written communication skills. - Being able to sit or work in a dedicated workspace for entire work shift. - Strong data entry, typing skills and proficiency in the use of a PC, including use of multiple applications simultaneously. - Evernorth systems, MS Outlook and Epic EMR knowledge a plus. - Experience with Epic and MyChart is preferred - At least 1 or more years of Medical Office experience. - Demonstrated strong communication skills by expressing thoughts and information clearly and succinctly using proper business English and correct grammar. - Ability to succeed within a team environment. - Professional interaction with customers, internal & external - Compliance with HIPAA regulations and Evernorth Workplace Care guidelines. Bonus Points for: - Passionate about going above and beyond - Independent worker and self-starter - Customer-centric Focus - Dynamic personality This position is a remote position The hours for this role are Monday – Friday TBD (covering all US time zones) We offer benefit eligibility from the first day of employment, Paid Time Off, Short and Long-Term Disability, Life Insurance, 401k with company match, Continuing Education, Career Development and a variety of other perks. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 17.75 - 19 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.