Bluffton, South Carolina, Berkeley, Missouri, Colorado Springs, Colorado
Melbourne, Florida, Plainville, Connecticut, Plainville, Connecticut, Chattanooga, Tennessee, Salt Lake City, Utah, Texas, Virtual US
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?
Bluffton, South Carolina, Berkeley, Missouri, Colorado Springs, Colorado
Melbourne, Florida, Plainville, Connecticut, Plainville, Connecticut,
Theremote work(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 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 use 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
This role is also anticipated to be eligible to participate in an annual bonus plan.
Helping our customers achieve healthier, more secure lives is at the heart of what we do. While you take care of our customers, we’ll take care of you through a comprehensive benefits program that helps you be at your best. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and best in class 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 dozens of corporate discounts on essentials you use every day. For more details on our employee benefits programs, please visit the “Life at Cigna” tab on our career site: www.cigna.com/careers
For this position in Colorado, we anticipate offering an hourly rate of 13.56, +/- 10%, depending on experience.
Senior Liability Adjuster (Claims Senior Analyst)- Work from Home
Location: This position can be remote-work at home. Some travel to the Egg Harbor Twp, NJ office may be expected for training/meetings. Up to 25%
This position is not eligible to be performed in Colorado
POSITION SUMMARY
Independently investigates, evaluates, and resolves assigned liability claims of a more complex or litigated nature in a timely manner in accordance with legal statutes, policy provisions, and company guidelines.
KEY RESPONSIBILITIES:
Understand concepts of coverage, policy interpretation, exposure recognition, and liability determination to analyze and move claims toward resolution using Best Practices.
Promptly investigate all assigned claims for coverage, liability assessment, and damages.
Investigate claims by interviewing claimants and witnesses, establish claim reserves, handle evidence, obtain evidence, obtain and interpret official reports, medical reports and claim forms, and attend/participate at mediation, trials or hearings.
Negotiate and settle claims, set reserves and manage litigation within client service parameters and authority levels by obtaining demands and making offers to claimants.
May present evidence at legal proceedings.
Direct appraisal and/or inspection of damaged property.
Dispose of salvage and pursue subrogation when appropriate.
Report all serious injuries/liability issues and potential large loss claims to the client and/or reinsurer based upon the criteria provided by the client.
Document plan of action in the claim system and set appropriate diaries.
Manage diary and complete tasks to ensure that cases move to the best financial outcome and timely resolution.
Close all files as appropriate in a timely and complete manner.
Maintain closing ratio as directed by management team.
Attend/participate at mediation, trials or hearings.
Attend external client meeting/seminars
Routinely interact with clients, claimants, attorneys, investigators, experts and other vendors.
Complete PARs (payment authorization request) when applicable.
Comply with all excess and reinsurance reporting requirements; manage self-insured retention reporting.
Communicate effectively, verbally and in writing with internal and external parties on a wide variety of claims and account-related issues.
Provide a high degree of customer service to clients, including face to face interactions during claim reviews, meetings, and similar account-specific sessions.
Provide assistance with company education and training.
COMPETENCIES
Confidentiality – Possesses high level and regard for confidentiality.
Dependability – Is trustworthy, reliable, and accurate.
Detail Oriented – Focuses on details to obtain a quality work product.
Follows Direction – Acts in accordance with instructions.
Judgment - Forms an opinion objectively and with discretion.
Organization – Is able to plan and carry out activities effectively.
Problem Solving – Evaluates information and situations, approaching and resolving in a timely manner.
Teamwork – Promotes cooperation and commitment within a team to achieve goals.
Time Management – Plans and controls time to effectively accomplish goals.
Work Ethic – Is hard-working, diligent, reliable, and has initiative.
QUALIFICATIONS
High School diploma required; Associate’s or Bachelor’s degree preferred
At least 5-6 years of experience handling liability claims required, experience with bodily injury, professional liability with public entities including school boards. Experience with NJ claims required.
Completion of liability training courses internally and/or externally in all significant areas affecting liability claims handling and practices.
Expertise in liability and related claims handling practices and ability to apply same
Deep knowledge of client and carrier claims procedures
Significant understanding of self-insured retention, excess and reinsurance reporting; fluent in medical terminology and medical/injury treatments.
Liability licenses, certifications, awards preferred.
Proficient with MS Excel and Word; computer experience with related claims software
Excellent verbal and written communication skills
Proven interpersonal skills capable of dealing with all levels of personnel
Exceptional ability to multi-task and manage priorities
Excellent negotiation skills
Superior organizational and decision-making skills
Customer-focused orientation
Strong analytical and strategizing skills
Chattanooga, Tennessee,
Job Description
Claims Intake/Correspondence Representative
Excited to grow your career?
Cigna Supplemental Health Solutions (SHS) continues to grow and be there for our customers, with the aim of providing excellent service.
To continue to drive our Customer & Employee Engagement, SHS is creating a new and exciting opportunity within our Claims team. We are looking to recruit Claims Representatives. The successful candidates will be responsible for the full end to end process of the customer claims journey and will have the opportunity to grow their career.
Group Claims Associate Representatives help our customers maintain their health, well-being and sense of security by ensuring supplemental benefit claims are processed accurately and timely for our policy holders while protecting the confidentiality of our customer’s personal health information. Delivers basic technical, administrative, or operative Claims tasks. Examines and processes paper claims and/or electronic claims. Completes data entry, maintains files, and provides support. Understands simple instructions and procedures. Performs Group Claims duties under direct instruction and close supervision. Work is allocated on a day-to-day or task-by-task basis with clear instructions.
This role also requires a truly agile approach: we will expect you to routinely flex between activities where customer demand and need is greatest, and you may also need to flex your shift based on customer demand.
Main Duties / Responsibilities:
Be proficient and become an expert in all SHS claims activity
Adapt to and positively influence change by accepting feedback with a growth mindset to continuously improve
Adhere to all Compliance regulations and requirements
Analyze claim information and triage the facts to determine if further information is needed or what action must be taken
Ability to make outbound calls to healthcare providers to gather additional information
Follows established policies and procedures to complete claims within established time frames
Complies with all ongoing training associated with role and business needs
Team members will be held accountable for meeting or exceeding minimum quality, accuracy, and turn-around time standards through use of Management Operating Systems (MOS) and other reporting systems
Skills:
High School Diploma or equivalent required. Bachelor’s Degree preferred
Must possess excellent attention to detail, with a high level of accuracy
Proficient in Microsoft Office applications; Excel, OneNote, Outlook, PowerPointproblem-solve, and Word
Insurance experience preferred
Integrity and personal accountability for job performance and expectations
Excellent organizational, interpersonal, written and verbal communication skills
Ability to learn process and product information and adapt quickly and effectively
Demonstrated ability to problem solve, using analysis skills, experience, and judgment to make accurate decisions.
After completion of the application, be sure to complete the required assessment to continue in the hiring process.
As an Intake Representative in eviCore healthcare’s Non-Clinical Call Center, you will serve as the main point of contact for inbound callers as you manage their benefits needs from start to finish. This includes processing requests for service, speaking with physicians’ offices and sites where the procedures will take place, as well as capturing and entering the necessary demographic and medical information in order to build the case file. You will also provide status updates and serve as a liaison to our clinical staff when needed.
Upon joining us, you will attend 6 weeks of in-depth training to help ensure your success here at eviCore healthcare. After training, a mentor and supervisor will guide your performance as you take inbound calls from doctor's offices and/or diagnostic centers, through a computer generated system. The ability to multitask will be key, as you will be listening, entering information, completing Internet searches, and asking probing questions. Specifically, you will:
Process Review of Service Request notifications that do not require certification of medical necessity
Promptly transfer Review of Services calls which cannot be completed via the formal script to a Clinical First Level Reviewer or Medical Reviewer for completion
Work with sites, patients and physician’s offices to investigate and resolve any pre-certification questions or concerns and preempt unanticipated issues
Provide professional, courteous and accurate information to all callers
What You Should Have
A strong customer service orientation and commitment to providing outstanding service
Strong attention to detail
Professionalism and a strong work ethic; the ability to excel and meet your responsibilities in a highly structured environment
The ability to work independently and as a reliable team member
An upbeat attitude with a coachable persona
Inquisitiveness and the desire to continually learn and improve
Wondering what a typical, day in the life of a Non-Clinical Contact Center employee looks like?
NOTE: We are currently training in a work at home environment, and you will be required to have reliable internet connectivity provided through a wired connection. A mobile or hot spot environment is not acceptable and you may need to purchase an Ethernet cord depending on your current setup
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 providing the knowledge you need to excel
A training lab where you take live calls with a training supervisor close by to answer questions
A monthly pay for performance bonus incentive
A clear path for advancement, with eviCore’s CoreMap showing your unique path to future opportunities!
18 days of PTO per year plus paid holidays
Health, dental, vision, and life benefits with employer-funded HSAMonthly.
Memphis, Tennessee,
A Customer Service Rep III is responsible for performing advanced and complex customer service functions; Customer setups, credit/debit/rebills, email support, and first level escalation resolution. They will also support the team with order placement, credit requests, RGA's, as well as, understand the specific Department metrics (such as Call Abandonment, Call Quality, and Attendance); while demonstrating an ability to achieve performance for the specified skills listed above. This individual proactively recognizes cause and effect trends, identifies and clarifies customer needs, and works toward solutions. The position requires the ability to maintain effective relationships with the customer base to ensure the effective delivery of superior customer service. This individual needs the ability to resolve customer issues through process expertise without having to escalate to higher levels of Management but also understands when higher level of authorization is required. This individual needs a friendly, confident disposition, a passion for talking on the phone, inquisitive and helpful nature.
Essential Functions:
Independently resolves basic customer conflicts including but not limited to: product, order placement, credit requests and returns.
Demonstrates intermediate knowledge of Customer Support Department organization to aid in issue escalation, knowledge of policies and procedures, and mastery of routine skills.
Demonstrates technical proficiency to access customer account information, product information, and pricing/contract information to solve problems.
Effectively collaborate with internal departments to resolve customer issues, including the sales, credit and distribution center departments.
Multi-task between several issues at one time.
Understands department Policies and procedures.
Is able to resolve customer issues through process expertise without having to escalate to higher levels of Management but also understands when higher level of authorization is required.
Qualifications:
High school diploma or G.E.D. required.
Customer service experience is required, preferably in a call center environment.
Basic knowledge of customer orders, Excel, Word, Office, shared mailboxes, SharePoint.
Excellent phone presentation and communication skills.
Demonstrated ability to handle challenging customers in a professional manner.
Willingness to work a flexible task list.
Ability to multi-ta
Virtual, US
POSITION SUMMARY
The Advanced Therapies Area within Accredo is a growing component of the Specialty organization.
The Advanced Therapies Resource Management lead analyst collaborates with the Resource Management team and Operations Management to provide tactical plans for executing resource deployment. The analyst performs retrospective metrics analysis for continuous improvement opportunities, monitors the day to day workflow and makes future recommendations to ensure cost and service level goal attainment.
The lead analyst role gathers and utilizes data from the forecasting, operations, training/recruiting and intraday teams to create and manage performance aligned to business objectives to support the operations team priorities.
The analyst should be a self-led, independent contributor with solid communication skills thriving in a sometimes multi-tasking environment that allows them to focus on analytical detailed work. They will proactively approach their partner groups with a drive for collaboration and always be open for continual improvement feedback.
Key responsibilities include:
Create daily, weekly, and monthly schedules using the Aspect eWFM software. Identify forecast requirement vs schedule variances and collaborate with the operations team to adjust schedules accordingly to insure cost and service level goal attainment.
Provide retrospective analysis of schedule performance and continuously improve the process. Identify schedule gaps and opportunities. Present proposals to resolve any issues.
Update PTO allowances and ensure the business has the appropriate number of hours by group to meet its goals while providing time off to employees.
Collaborate with operations partners to schedule hours that accommodate the short range resource plan and close any gaps using Overtime and Voluntary Time Off.
Schedule training, meetings, and offline activities according to priority and availability of staff to meet our service level goals.
Optimize breaks and lunches using the Aspect eWFM scheduling software.
Create new hire schedules and process terminations.
Plan for observed and non-observed holiday schedules.
Maintain headcount and agent profile data (skills, location, hire dates, etc.) in the Aspect eWFM scheduling software.
Create staffing charts with regular cadence for operations to review staffing levels for any gaps.
Understand the scheduling process in detail and provide continue feedback loop for improvement.
Ability to create standard SOP’s related to job role and to drive process improvement.
Additional duties as assigned.
Qualifications
High school diploma or GED
Bachelor’s degree preferred
2-5 years relevant analyst experience
Workforce planning analysis in an operations environment preferred
Knowledge of Accredo operations and systems preferred
Strong analytical and technical skills.
Demonstrated knowledge of MS Office software, specifically Excel (v-lookups, pivot tables, macros)
Prior experience with Workforce Management software (Aspect WFM, Verint, NICE, etc.) preferred
Excellent analytical, communication and presentation skills
Proven ability to perform in-depth data analysis and present insights in a clear manner
Ability to adapt in a dynamic work environment, learn quickly, solve problems and make decisions with minimal supervision
Ability to prioritize and meet timelines and deadlines
Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve complex issues with innovative solutions.
Colorado Springs, Colorado, Virtual, US
After completion of application, be sure to complete the required assessment to continue in the hiring process.
Ready for a job that encourages you to use your communication skills and attention to detail? As an Intake Representative in eviCore healthcare’s Non-clincal Call Center, you’ll use your commitment to outstanding service and upbeat attitude to serve as the main point of contact for inbound callers as you manage their benefits needs from start to finish.
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 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 providing the knowledge you need to excel
A training lab where you take live calls with a training supervisor close by to answer questions
18 days of PTO per year plus paid holidays
Health, dental, vision, and life benefits with employer-funded HSA
Monthlyopportunities pay for performance bonus incentive
A clear path for advancement, with eviCore’s CoreMap showing your unique path to future opportunity!
NOTE: This is a work-from-home opportunity and you will be required to have reliable internet connectivity provided through a wired connection. A mobile or hot spot environment is not acceptable and you may need to purchase an Ethernet cord depending on your current setup.
**Work at home opportunity
Role Summary
The Cigna Easy Choice Tool and MyCignaPlans are Pre-enrollment decision making websites designed to assist employees in choosing the appropriate plan based on their specific needs. The position is accountable for assigned client installations, renewals, and change orders . Using a variety of tools, this individual will be able to complete the setup of client-specific variables in the Cigna Easy Choice Tool Configuration portal as well as MyCignaPlans. Quality Control validations in each site is also part of the role. In addition, the position develops relationships with and provides complete, accurate, and timely responses to internal and external partners.
Responsibilities:
Educates SIL's and Cigna counterparts on the Cigna Easy Choice Tool and installation process.
Manages multiple implementations, renewals, and change orders concurrently.
Gathers requirement information from account management.
Work directly with Cigna business partners in reviewing and understanding client specific requirements.
Maintains ongoing knowledge of our product and processes Responsible for test plan development, test case development, and test execution of client configurations in the Cigna Easy Choice Tool.
Test end user to ensure a pleasant customer experience Actively locate, track, report, and regress errors found during testing.
Provide accurate project status in the Clarizen application Assesses the effectiveness of the CECT installation end to end process and recommends and helps implement improvements as necessary.
The Cigna Easy Choice Tool Installation Specialist typically has a minimum of 1 years' experience employer services.
Skills Requirements:
High School Diploma or GED is required
Excellent written and verbal communication skills are critical to effectively communicate with internal and external business partners required.
Strong communication, problem-solving and decision-making skills
Attention to detail is critical to effectively handle the technical aspects of the job required.
Excellent organization skills to be able to multi-task and meet increasingly tight deadlines.
Strong interpersonal skills to work with many different personalities and styles.
Excellent Microsoft office suite skills including Excel and word, highly preferred.
Self-motivated, detail oriented, and willingness to adapt to changing department and company needs. detail-oriented.
Virtual, US
The Grievance team manages Cigna Medicare/Medicaid grievances that are presented by our members or their representatives pertaining to the authorization of or delivery of clinical and non-clinical services. Grievance works in collaboration with divisions within and outside the organization to resolve issues in a timely and compliant manner.
Grievances coordinator position is focused on the processing of Medicare customer grievances. This associate may screen incoming complaints received orally or in writing, conducting root cause analysis as needed, creating an action plan, coordinating and communicating resolutions, as well as documenting systems in detail with case notes related to Customer grievances with in CMS guidelines.
Duties and Responsibilities:
The grievance Coordinator is responsible for corresponding with members, providers and regulators regarding decisions and actions.
Works collaboratively with the Claims, Customer Service, Appeals, and Medical Management Departments.
Communicate, collaborate and cooperates with internal and external business partners.
Adheres to all Compliance/Program Integrity requirements and complies with HIPAA Regulations.
Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency.
Supports department-based goals which contribute to the success of the organization.
CANDIDATE QUALIFICATIONS:
Bachelors or associates degree in related field; in lieu of a degree, a high school diploma and two years in a Medicare, Medicaid managed care environment investigating and resolving Grievances.
One year of health insurance/managed care experience knowledge of healthcare terminology preferable.
Strong written and verbal communication skills, PC proficiency to include Microsoft office products.
One year of health insurance/managed care experience performing Appeals and Grievances functions.
Will consider managed care associates with three years of experience in customer service, call center or claims processing skills and knowledge of healthcare delivery.
Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment.
Demonstrated written communication skills, time management, priority setting, problem solving and organizational skills.
Demonstrated ability to converse with and collaborate with physicians and physician personnel.
Ability to identify and define problems, collect data/information, establish facts, and draw valid conclusions and provide resolution.
Ability to track and manage caseload effectively in a Grievance tracking system
Must be able to work independently and under pressure related to tight time-frame
Must be a current contractor with Cigna, Express Scripts, or Evernorth. Evernorth is a new business within the Cigna Corporation.
Houston area or Nashville Area--This position is not eligible to be performed in Colorado
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
.Virtual, US
Location: Remote, Work at Home
As a Medicare Claims Manager, you will support the claims team with the management and implementation of projects and process improvements in Service Operations with special focus on claims processing from end to end. At the same time, you will support the Service Operations Team on overarching projects and strategies to achieve the metrics.
In this role, you will interface with a variety of business partners, external vendors, technology specialists and managers. The successful candidate in this role will have experience in leading teams focused on using data to identify opportunities to improve outcomes, to improve and maintain Claims metrics performance.
Job content:
Recommend, support and implement innovative strategies to improve overall claims timeliness and quality, in a cost effective manner.
Play active role in projects and process improvements including being the business contact person to gather business requirements, guide and develop action plans and implementation strategies.
Be proactive in identifying improvement/enhancement opportunities and active in seeking and sharing ideas for innovation in business processes across operations.
Support the claims team in achieving departmental and company-wide goals and business plans.
Support Service Operations Team in achieving the overall metrics, work on improvement actions across the teams and engage the teams in payment improvement actions.
Communication of outcomes at all levels of the organization
Support team members through continual engagement, focused on professional development
Reduce medical and operational cost through innovative strategies
Specific Knowledge:
At least 5+ years of experience in managed care operations, health care or medical industry preferred
At least 3+ years of proven leadership or management experience required
Bachelor’s degree highly preferred or equivalent work experience
Medicare Claims knowledge and experience strongly preferred
Working knowledge with government programs preferred
Ability to manage successfully internal relationships with cross-functional teams
Demonstrated business process analysis skills
Successful track record of timely delivery of tasks with high quality and eye for detail
Proven ability to get into the details of projects in order to drive them to successful execution
Experience in owning and driving user acceptance testing and business adoption
Ability to multi-task
Advanced knowledge of Microsoft Office - and proprietary IT application, QNXT experience hul. This position is not eligible to be performed in Colorado.
Comments