Provider Relations & Claims Advocate - Evernorth Behavioral Health - Remote
The job profile for this position is Case Management Analyst, which is a Band 2 Senior Contributor Career Track Role.
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!
Our people make all the difference in our success.
The Claims & PR Advocate is a phone queue-based position responsible for servicing inbound claim-related calls from members, providers, and provider office staff. Advocates will handle back-to-back calls throughout the day, with occasional outbound calls required to resolve claim issues. This role demands strong multitasking, technical proficiency, and independent problem-solving skills.
Note: This position requires a Bachelorâs degree to qualify.
Key Responsibilities:
⢠Answer inbound calls from members and providers regarding claims, contracting, and provider relations.
⢠Work in a structured call queue environment, handling a high volume of calls daily.
⢠Make outbound calls as needed for issue resolution or follow-up.
⢠Use multiple applications during calls to research and resolve inquiries.
Call topics may include:
⢠Claim status inquiries and explanations
⢠Requests for claim reprocessing or adjustments
⢠Provider contract questions and demographic updates
⢠Authorization corrections to ensure proper claim payment
⢠Requests for duplicate EOBs or check reissuance
⢠Escalated issue handling via Advocate Handoff/Help Request (AHHR)
⢠Complaint submissions on behalf of members or providers
⢠Emailing resources and documentation to callers
Required Skills:
⢠Proven customer service experience
⢠Prior experience in Evernorth Behavioral Care Specialist/Advocacy role preferred
⢠Experience handling behavioral health claims and provider relations calls is a plus
⢠Ability to thrive in a virtual team environment
⢠Strong interpersonal and communication skills
⢠Effective listening and organizational abilities
⢠Technical aptitude with multiple systems and applications
⢠Independent problem-solving and time management skills
⢠Proficient typing and PC skills
Training Schedule:
⢠Monday through Friday, 8:30 AM â 5:00 PM CT
Work Schedule:
⢠After training, shifts are Monday through Friday between 7:00 AM â 7:00 PM CT
⢠The recruiter will provide specific shift options
Education Requirement:
⢠Bachelorâs degree is required
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 - 36 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.
We want you to be healthy, balanced, and feel secure. Thatâs why youâll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, youâll 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.
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.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Apply Now
Apply Now
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply!
Our people make all the difference in our success.
The Claims & PR Advocate is a phone queue-based position responsible for servicing inbound claim-related calls from members, providers, and provider office staff. Advocates will handle back-to-back calls throughout the day, with occasional outbound calls required to resolve claim issues. This role demands strong multitasking, technical proficiency, and independent problem-solving skills.
Note: This position requires a Bachelorâs degree to qualify.
Key Responsibilities:
⢠Answer inbound calls from members and providers regarding claims, contracting, and provider relations.
⢠Work in a structured call queue environment, handling a high volume of calls daily.
⢠Make outbound calls as needed for issue resolution or follow-up.
⢠Use multiple applications during calls to research and resolve inquiries.
Call topics may include:
⢠Claim status inquiries and explanations
⢠Requests for claim reprocessing or adjustments
⢠Provider contract questions and demographic updates
⢠Authorization corrections to ensure proper claim payment
⢠Requests for duplicate EOBs or check reissuance
⢠Escalated issue handling via Advocate Handoff/Help Request (AHHR)
⢠Complaint submissions on behalf of members or providers
⢠Emailing resources and documentation to callers
Required Skills:
⢠Proven customer service experience
⢠Prior experience in Evernorth Behavioral Care Specialist/Advocacy role preferred
⢠Experience handling behavioral health claims and provider relations calls is a plus
⢠Ability to thrive in a virtual team environment
⢠Strong interpersonal and communication skills
⢠Effective listening and organizational abilities
⢠Technical aptitude with multiple systems and applications
⢠Independent problem-solving and time management skills
⢠Proficient typing and PC skills
Training Schedule:
⢠Monday through Friday, 8:30 AM â 5:00 PM CT
Work Schedule:
⢠After training, shifts are Monday through Friday between 7:00 AM â 7:00 PM CT
⢠The recruiter will provide specific shift options
Education Requirement:
⢠Bachelorâs degree is required
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 - 36 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.
We want you to be healthy, balanced, and feel secure. Thatâs why youâll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, youâll 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.
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.
Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Apply Now
Apply Now