Provider Relations & Claims Advocate
Cigna · Remote US
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About the Job
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 Bachelor’s 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 – 5:00 PM CT
Work Schedule
- After training, shifts are Monday through Friday between 7:00 AM – 7:00 PM CT
- The recruiter will provide specific shift options
Education Requirement
- Bachelor’s 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 - 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.