Manager, Complaints and Issues (Claim CTMs)

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

Position Purpose: Ensures complaints and issues team document customer complaints and issues (I.e., grievances, appeals, Claims Tracking Module) based on regulatory and other contractual legal requirements. Reviews complex inquiry documentation to ensure adherence to quality and regulatory standards.

• Manages the team responsible for customer complaints and issues resolution teams by planning, directing, and evaluating team performance, and collaborating with other departments to ensure customer satisfaction
• Manages identified trends in customer complaints, issues, and processes and influences senior leadership on recommended solutions
• Provides guidance to team members on complex customer complaints and issues identified
• Maintains knowledge of all policies, procedures, and regulations to ensure compliance requirements are achieved
• Escalates issues and problems to senior leadership, including potential and/or documented regulatory issues and provide solutions
• Manages integration of federal and state law changes into company’s regulatory system related to customer complaints and issues
• Promotes and drives strong collaboration and feedback loop between other departments to achieve and improve cross-functional impact
• Partners with complaints and issues team to ensure consistent adherence to documented workflow guidelines and established procedures
• Partners with senior leadership to provide performance reviews and oversee the development and implementation of trainings
• Assists senior leadership within team in onboarding, hiring, and training new employees within the customer complaints and issues department
• 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, 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