Claims & Provider Relations Advocate - Evernorth Behavioral Health - Remote

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

The types of calls a Claims & PR Advocate service 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 to carry out the responsibilities of this role. Calls must be serviced helpfully and professionally.

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. Please note that occasional outbound calls may be necessary to address issues that require additional attention.

Within a call, a Claims & PR Advocate may:

• Assist a member or provider with understanding how a claim has been 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
• 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

Skills

• Customer Service experience
• Bachelor's degree in the mental health field or psychology/social work-related field (family communications, health coaching, community/public health, or other related major), OR a bachelor’s degree in an unrelated field and 2+ years of experience in the behavioral health field.
• Experience in the Evernorth Behavioral Care Specialist/Advocacy role
• 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

Training

Training hours are Monday through Friday, 8:30 AM – 5:00 PM CT.

Work Schedule

Once training is complete, standard shifts occur Monday through Friday, 7:00 AM – 7:00 PM CT. The recruiter will share specific shift opportunities.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, 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, visit Life at Cigna Group.

About Evernorth Health Services

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: [email protected] for support. Do not email [email protected] 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.

Originally posted on Himalayas

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