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Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being, and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas, and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make? Read employee reviews benefits and salaries here
USA Work from Home - Accredo
USA Work From Home Opportunity
** Work schedule is 8 am and 5 pm CST
Follows standard operating procedures to review and post medical payments on basic outstanding claims in pursuit of reducing the company's accounts receivable. Requires basic knowledge of the billing and collections processes and general supervision for routine work
Responsibilities
Medical Accounts Receivable
Deposit/Cash Posting Experience
Research/analyze/correct complex cash posting issues
Read/Understand Medical Explanation of Benefits (remit)
Contact Medical Payors regarding complex payment issues
Documenting chart notes accurately
Escalate unresolved complex issues as needed
Qualifications
Experience posting medical payments REQUIRED.
High School diploma; Bachelor's degree preferred.
Two Years’ experience in medical insurance environment is helpful, but not required.
Prior Reimbursement experience preferred.
Proficient in using Excel (filter, sort, and search)- REQUIRED
Analytical skill-set needed.
Experience working with a PC and MS Office.
Strong attention to detail.
Excellent retention and judgment ability.
Proficient written and oral communication skills.
Ability to work in a fast-paced, payment processing environment.
Reliable, self-motivated with excellent attendance.
Team player who has the ability to stay on task with little supervision.
**This role is WAH/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.
The Eligibility Supervisor is responsible for tracking the performance of the billing line team including conducting quality reviews, handling patient escalations, coaching, policy enforcement, and process improvement ideas.
ESSENTIAL FUNCTIONS:
Leads a team of phone representatives to provide a high quality of customer service to our patients through coaching, accountability, and finding ways to make it easy to help our team to help our patients. The billing line aims to resolve patient concerns regarding their balance including copay assistance, customer refund requests, statement inquiries, etc. The supervisor would provide input on process changes, conduct quality reviews, holding the team accountable to their schedules through monthly 1:1’s and coaching.
QUALIFICATIONS:
0-2 years of experience
Bachelor’s degree preferred.
Previous leadership experience preferred.
Strong knowledge of copay assistance and insurance billing, required.
Strong knowledge of Microsoft Office Products, RxHome, ESD, TMW, Bluezone
Must possess excellent oral and written communication skills
Must be self-motivated and not afraid to act autonomously when needed.
ABOUT THE DEPARTMENT
Through our range of health care products and services offered, Accredo team members provide in-depth care for patients with chronic health conditions like hemophilia, oncology, rheumatoid arthritis, and growth hormone deficiency. In addition to health care products, we provide comprehensive management services – including outcomes measurement, counseling, clinical care management programs, social services, and reimbursement services. By performing in these very high-touch roles, employees have a daily opportunity to make a positive impact on their patients’ lives.
As an Eligibility Representative, you will be part of a team passionate about helping our patients with billing and ensuring their access to life-saving medications.
What you’ll do:
Facilitates cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time
Independently resolve basic patient claims issues using key subject matter knowledge
Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates, and authorizations
Effectively collaborate with internal departments to resolve issues or provide any needed information
Contact benefit providers to gather policy benefits/limitations
Coordinate and ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.)
Perform medical/pharmacy benefits verification requiring complex decision skills based on payer and process knowledge
What you’ll need:
High school diploma or GED
3-5 years of relevant working experience
Experience with health care, medical insurance terminology and patient access preferred
Strong data entry skills and computer skills
Excellent phone presentation and communication skills
Demonstrated ability to handle difficult conversations in a professional manner
Ability to adapt in a dynamic work environment and make decisions independently
Advanced problem-solving skills and the ability to work collaboratively with other departments
As a Customer Service Supervisor, you will be responsible for the day-to-day operations of a team of associates in a call center and monitor productivity and performance standards. You will also plan and direct workflow and project assignments. You will need to recognize and recommend operational improvements along with developing and implementing manual outbound call campaigns with specific teams from inbound.
What you’ll do:
Manage a team of associates to promote a working team environment and ensure best practices are shared. Works to develop employees’ skills, evaluates performance and provides feedback. Oversees resolution of employee relations issues. Conducts hiring, training and evaluation of staff. Ensures challenging conversion goals are met.
Provides on-going coaching to each associate on their team concerning quality, reliability, accountability, conversion and productivity. Responsible for achievement of service levels and performance guarantees.
Work with Senior Manager to develop strategic business work plan goals. Tracks and periodically reports progress to senior management.
Assists in the development of programs and process improvements to enhance the level of internal and external customer service provided.
Serves as point of escalation for issues and calls requiring a higher degree of expertise or direction to resolve customer issues to ensure a timely resolution. Backs up platform team. May perform any of the specialist duties when needed.
You will oversee call volume and back-end workflow to ensure service standards are met. Responsible for team’s adherence to corporate attendance and employment policies. Works with TRO to develop policies, procedures, and the business work plan for the team. Special projects as needed
Qualifications
High School Diploma or equivalent required. Bachelors’ Degree preferred
2+ years of legacy Cigna Customer Service or Contact Center experience highly preferred
2+ years as a Coach, Lead, or Escalated Call Team Representative highly preferred
General PC knowledge including Microsoft applications and call center platforms.
Demonstrated understanding of operating a call center including ability to manage average call time, response time, and call volume
Ability to motivate employees, handle difficult employee relations issues and create a culture that supports high employee morale
Focus on quality customer service
Demonstrated ability to meet multiple deadlines and manage heavy workload
Excellent verbal and written communication skills
Ability to handle sensitive or confidential information is critical
Hours of operation are from Monday through Friday from 8a-8p EST. The expectation is to support during core hours of operation between 8a-5p EST.
This role is full time Work at Home and will require reliable internet connectivity provided through a wired connection. A mobile or hot spot environment is not acceptable.
Job Description
Does your dream job involve a healthy mix of helping others, problem-solving, and a supportive, family-like team environment to top it all off? What about a starting pay of $16 - $18 an hour based on experience & education, medical benefits that start on day one, and 8 hours of paid time off to volunteer with causes you’re passionate about? We thought so.
Here’s a little more about what you’ll do:
Help clients, customers, and health care providers understand our business a little better. Topics like determination of payments and claims related to medical and dental procedures and office and hospital visit costs are common questions.
Make it easy for customers to work with us. Take ownership of their issues and do your best to resolve them over the chat the first time, every time.
Be an advocate for health and wellness. Educate customers on disease management programs and make recommendations on the right healthy living programs for their needs.
Access regular development opportunities and mentorship as you train with the best team in the industry. We offer extensive, hands-on training and guided on-the-job training to ensure you’re successful here (and enjoy your job too!)
Enjoy the perks of working in a wellness-oriented industry. Being at the frontline of customer problem solving can be tiring, so we do our best to look after you, too, by offering things like on-site gyms and cafeterias, massage appointments, and social activities.
What you should have:
High School Diploma or equivalent required, Associates or Bachelor’s degree preferred
1+ years of customer service experience analyzing and solving customer problems required;
Intermediate proficiency in Microsoft Office Suite; high-level capacity to multitask independently and on a computer
Knowledge of Medical Terminology a PLUS
Excellent written and oral communication skills
Exceptional organizational and time-management focus.
Work from home - Colorado Springs, Colorado, United States of America Virtual, US
Here’s a little more on how you’ll make a difference:
Ensure process efficiency – Process requests for service, speak with physicians’ offices and procedure sites and capture the necessary demographic and medical information in order to build case files.
Be a team player – Provide status updates and serve as a liaison to our clinical staff when needed.
Create new knowledge with our computer systems and new relationships with your peers – You’ll start with 6 weeks of in-depth training, but you’re not doing it alone. After training, a mentor and supervisor will guide your performance by taking inbound calls through a computer-generated system. You’ll enjoy a supportive environment with your peers and other teams who want you to succeed.
What you should have:
High School Diploma / GED required
A strong customer service orientation and commitment to providing outstanding service
Professionalism and a strong work ethic; the ability to excel and meet your responsibilities in a highly structured environment
Excellent verbal and written communication skills
Why join us?
6 weeks of classroom and training lab, including:
Best in class call center training program
A classroom environment, live trainer, and open discussion
A proven curriculum provides the knowledge you need to excel
A training lab where you take live calls with a training supervisor close by to answer questions
Virtual, US
Our people make all the difference in our success.
As a Customer Service Supervisor, you will be responsible for the day-to-day operations of a team of associates in a call center and monitor productivity and performance standards. You will also plan and direct workflow and project assignments. You will need to recognize and recommend operational improvements along with developing and implementing manual outbound call campaigns with specific teams from inbound.
What you’ll do:
Manage a team of associates to promote a working team environment and ensure best practices are shared. Works to develop employees’ skills, evaluate performance, and provide, feedback. Oversees resolution of employee relations issues. Conducts hiring, training, and evaluation of staff. Ensures challenging conversion goals are met.
Provides ongoing coaching to each associate on their team concerning quality, reliability, accountability, conversion and productivity. Responsible for achievement of service levels and performance guarantees.
Work with Senior Manager to develop strategic business work plan goals. Tracks and periodically reports progress to senior management.
Qualifications
High School Diploma or equivalent required. Bachelors’ Degree preferred
2+ years of legacy Cigna Customer Service or Contact Center experience highly preferred
2+ years as a Coach, Lead, or Escalated Call Team Representative highly preferred
General PC knowledge including Microsoft applications and call center platforms.
Demonstrated understanding of operating a call center including the ability to manage average call time, response time, and call volume
Ability to motivate employees, handle difficult employee relations issues, and create a culture that supports high employee morale
Focus on quality customer service
Demonstrated ability to meet multiple deadlines and manage a heavy workload
Excellent verbal and written communication skills
The ability to handle sensitive or confidential information is critical
Hours of operation are from Monday through Friday from 8a-8p EST. The expectation is to support during core hours of operation between 8a-5p EST.
This role is full-time Work at Home and will require reliable internet connectivity provided through a wired connection. A mobile or hot spot environment is not acceptable.
Work from Home - AL, AZ, TN & TX--must live in/or near the area)
The Case Management Senior Representative is an integral member of the Cigna HealthCare of Arizona Population Health Management team, functioning under the direction of the clinical supervisor and/or designated team leader. This position provides professional, courteous, and friendly assistance to Cigna HealthCare of Arizona patients as they engage in the care delivery system.
The Case Management Senior Representative serves as a primary touchpoint for patients, acts as a strong patient advocate, and helps to break down barriers to care. Working with the care team, the Intake Care Senior Representative uses tools and guidelines, in addition to position-specific training, to make sure patients are engaged in self-advocacy and informed decision-making. By taking ownership over navigation through the health system and by ensuring that the patient has a knowledgeable and reliable advocate, the Case Management Senior Representative forms strong, valuable, and long-lasting relationships with patients
Work Schedule: M-F 9 am – 6 pm, and OT as needed
New Hire training 4-6 weeks; virtual classroom and then with Subject Matter Expert (SME)
Cigna equipment provided
RESPONSIBILITIES:
The primary point of contact for designated “Most Vulnerable” Chronic Special Needs Plan Medicare Advantage customers/other identified “high risk” Medicare Advantage customers needing care management services. Aligns patients to programs and services, provides reminder calls and acts as a liaison between the customer and the Care Coordinator/Disease Manager (CCDM) team.
Mails, collects, scans and telephonically assists customers to complete health risk assessments for both CSNP and Medicare Advantage Plan customers. Provides support to PHM program staff in all non-clinical HRA support functions. Also completes social work assessments to support Social Work staff.
Verifies patient eligibility based on line of business and associated benefits by utilizing appropriate software programs. Based on findings is able to connect patients to services available based on line of business.
Processes internal program referrals as needed. Follows through as appropriate to ensure the patient complies with referrals and services as recommended by the care team.
You must live in the state of Florida to be eligible for this position.
ESSENTIAL FUNCTIONS
Prepares and reviews claims to ensure billing accuracy.
Pursues collection activities to obtain reimbursement from payers and/or patients.
Frequent follow-up with payers and/or patients on outstanding accounts.
Escalates delinquent and/or complex claims to Sr. Billing & Reimbursement Specialists for appropriate action.
QUALIFICATIONS
High School Diploma or GED required.
2-3 years relevant experience.
PC Skills including Microsoft Outlook, Excel, Word, and Internet.
Detail-oriented and strong organizational skills.
Self-starter and team player.
Focus on quality and service.
Demonstrated ability to meet multiple deadlines and manage a heavy workload.
Integrity to handle sensitive or confidential information is critical.
Job Description:
Leads Customer Service team consisting of experienced administrative, operative, and or technical roles in the professional career track. Typically responsible for a large number of direct and indirect reports in a process or transactional operations environment. Coordinates schedules and workflow for the team. Focuses on team completion of assignments and routines. Ensures the orientation and training of employees. Responsibilities: - Manage the selection, hiring, training, development, performance assessments and disciplinary actions and coaching for staff. - Provide direction regarding overall objectives and assignments to assigned team. - Provide direction to staff for complex/sensitive member and provider inquiries, concerns, complaints, appeals, and grievances. - Develop and manage relationships with direct reports - Monitor individual and team internal metrics - Support 7 day week call operations - Monitor performance guarantee results as required - Proactively orients all employees. - Identifies customer needs and responds to inquiries with knowledgeable and timely responses - Ensures timely execution of compliance with Cigna standards for all customer types. - Identifies staff education opportunities and provides proactive training on a continuous basis. - Manages and promotes customer satisfaction. - Proactively manages the service requirements of the enterprise. - Identifies network gaps and recruits qualified employees in accordance with network needs. - Leads and provides oversight to projects or process improvement initiatives - Creates strong working relationships with the internal departments involved in claim and call resolution, contract load, and claims audit activities, and monitoring these activities - Serves as CIGNA advocate in the external community. - Facilitate appropriate meeting participation and follow-up activities. - Facilitates education and discussion on products, quality initiatives, etc. as identified Qualifications: - HS Diploma required - Bachelor’s Degree strongly preferred - A minimum of 4 years of experience in Service Operations in a call center environment or other relevant customer service experience required - Understanding of medical insurance products and associated customer issues, Medicare experience a plus - At least 1-2 years of previous management or team lead experience preferred - Experience communicating with providers a plus. - Customer service experience required, claims experience preferred - Demonstrated excellent oral, written, interpersonal, analytical, and negotiation skills. - Strong proficiency in MS Office and the ability to learn new software systems quickly.
The Physician Support Unit (PSU) Rep I position will answer telephone calls in the physician line queue, meeting departmental standards for speed of answer and call volume, in a professional and respectful manner. This individual will be skilled at understanding how to research and resolve any issues pertaining to the pre-certification process. This includes knowing when and where to refer callers as needed, and a full understanding of the appeals/reconsideration policy. This individual must be able to communicate professionally with the caller as needed. The PSU Rep I will also be responsible for watching the phone queue to maintain awareness of when the volume of calls is high. During these times, this role must not go on Aftercall, or Aux time, unless an urgent necessity. Additional responsibilities include:
Educating callers about the Health Plan requirements for pre-authorizations, reconsiderations, and appeals
Working with sites, patients, and physicians' offices to investigate and resolve any pre-certification issues and know where to transfer calls when appropriate.
Giving professional, courteous, and accurate information to all callers.
Maintaining a working knowledge of all process and procedure changes, CPT coding, and updated training materials and using these changes and processes according
Education: High School graduate or higher education. Experience:
Proficient in Isaac/Image One and case build required
Previous customer service, medical experience, including medical terminology, medical billing, and managed care preferred.
Experience with data entry and customer service.
Customer service focused with excellent communication skills
Ability to learn and adapt quickly in a fast-paced environment
Analytical and well versed in Health Plan specific rules, regulatory and statutory
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