Provider Relations & Claims Advocate - Evernorth Behavioral Health - Remote
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
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 and paid holidays. 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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.
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