Provider Relations & Claims Advocate

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Answer inbound calls from members and providers regarding claims, contracting, and provider relations • Handle a high volume of calls in a structured phone queue environment • Make outbound calls for issue resolution and follow-up • Use multiple applications during calls to research and resolve inquiries • Address claim status inquiries and explanations • Process requests for claim reprocessing or adjustments • Handle provider contract questions and demographic updates • Correct authorizations to ensure proper claim payment • Process requests for duplicate EOBs or check reissuance • Handle escalated issues through Advocate Handoff/Help Request (AHHR) • Submit complaints on behalf of members or providers • Email resources and documentation to callers

🎯 Requirements

• Bachelor’s degree is required • Proven customer service experience • Prior Evernorth Behavioral Care Specialist/Advocacy experience 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 • Availability for Monday–Friday shifts between 7:00 AM and 7:00 PM CT after training • Training availability Monday–Friday, 8:30 AM–5:00 PM CT • Cable broadband or fiber optic internet service with at least 10 Mbps download and 5 Mbps upload for home work

🏖️ Benefits

• Annual bonus plan eligibility • Medical benefits • Vision benefits • Dental benefits • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence • Work-from-home arrangement