Claims & Provider Relations Advocate - Evernorth Behavioral Health - Remote

The Claims & PR (Provider Relations) Advocate will service inbound claim calls from both members and providers or their office support staff across multiple claim platforms. Occasional outbound calls are required to resolve claim issues.

The types of calls a Claims & PR Advocate services may include but are not limited to: inquiries about claim status details, claim reprocessing or adjustment requests, provider contract questions or requests to update demographics. Due to the wide variety of call types, several applications are required to service these inquiries, and multiple applications are often needed within the same call. Independent problem solving, multitasking, and technical savvy are essential in order to be able to carry out the responsibilities of this role. Calls must be serviced in a helpful and professional manner.

Responsibilities

The primary responsibility of this role is to answer inbound claim calls from members or providers, as well as contracting and Provider Relations related calls from providers. The work environment is structured, and the majority of the day will be spent answering these calls from a queue. Occasional outbound calls may be necessary for issues requiring follow-up.

Within a call a Claims & PR Advocate may

• Assist a member or provider with understanding how a claim has processed
• Verify claim status for a member or provider
• Educate a member or provider on billing protocols
• Write or correct authorizations to ensure claims are paid correctly
• Send claims for adjustment/reprocessing within multiple claim platforms
• Request duplicate EOBs for a member or provider
• Send a request for a cancelled check copy, to reissue a check, or request a stop pay/do not reissue on a check
• Provide follow-up on issues by making outbound calls when necessary
• Send resources to members and providers via email
• Submit a complaint on the member or provider’s behalf
• Send an Advocate Handoff/Help Request (AHHR) for escalated or complex issues
• Assist providers with contract related inquiries and demographic updates
• Independently problem-solve to ensure accurate information is given, exceptional customer service, and first call resolution is achieved

Qualifications

• Customer Service experience
• At least 1 year experience taking Eligibility, Benefit, and EAP calls
• Able to excel and/or prior successful experience in a virtual team environment
• Ability to maintain a professional and positive image to members, providers, facilities, billing offices, etc.
• Candidate must possess superb interpersonal communication skills
• Effective listening and organizational skills, with the ability to manage multiple tasks
• Intuitive technical capabilities with the ability to quickly understand and apply working knowledge on several claim systems and applications
• Independent problem solving skills
• Strong time management skills
• Ability to type effectively and have strong PC skills

Work Schedule

Training hours are Monday through Friday 8:30 AM – 5:00 PM CT. Once training is complete, standard shifts occur Monday through Friday 7:00 AM – 7:00 PM CT .

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 24 - 37 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, paid holidays, and leaves of absence. 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.