Texas, Alabama, Arizona, Connecticut, Georgia,
Massachusetts, Mississippi, Ohio, Oklahoma, Oregon, Pennsylvania Washington, West Virginia, Bluffton, South Carolina, Berkeley, Missouri, Franklin, Tennessee, Melbourne, Florida, Plainville, Connecticut, West Seneca, New York,
About Cigna
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.
Work At Home-This position is not eligible to be performed in Colorado
Technical expert with depth or breadth of knowledge within Eligibility. Implements, updates, and maintains automated, direct connect, and/or manual eligibility data.
May handle National Accounts or more complex accounts.
Reconciles accounts for non-standard requests.
May provide technical support for the electronic procession of eligibility.
Ensures customer data is installed accurately and timely.
Analyzes formats that are customized directly by the client.
May act as a lead, coordinating and facilitating the work of others.
Supports the development of new and innovative solutions to complex problems.
May work directly with Systems to design formats.
This job is available in 13 locations
Texas, Alabama, Arizona, Connecticut, Georgia,
Massachusetts, Mississippi, Ohio, Washington, West Virginia,
Oklahoma, Oregon, Pennsylvania
Customer Advocates help our 90+ million customers make the most out of their Cigna benefits. 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 phone 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.
What you should have:
Must be willing to work a designated shift between 8 am-8 pm EST , Monday through Friday
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.
St. Louis, Missouri,
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.
responding to phone inquiries with care and detail.
How you’ll make a difference:
Be a superstar in the eyes of providers and patients alike: Initiate phone calls with physicians’ offices to deliver formulary information as well as handle inbound and outbound calls to educate patients on plan design and cost.
Use your expert problem-solving skills to help our patients be at their best every day: Work with patients and doctors to research issues with medication coverage to help patients get the medication they need.
Juggle multiple tasks without sacrificing attention to detail. You will be busy handling multiple requests at any given time as well as documenting information from your conversations in our computer system.
What You Should Have:
High School Diploma / GED required
1 year of relevant experience
General PC knowledge including Microsoft Office
Excellent communication skills (verbal and written)
]Albuquerque NM or Tempe AZ - Express Scripts
** Permanent work from home Albuquerque NM or Tempe AZ**
Care Advocate.
Our Patient Care Advocates have dedicated team members who excel at customer service, helping us elevate our patient care to new heights. In this crucial role, you are on the front lines with patients, responding to phone inquiries and addressing each with care, detail, and most importantly, empathy.
Here’s a little more on how you’ll make a difference:
Help patients understand their pharmacy benefits better. Use the knowledge you gain from training, your problem-solving skills and support from your team to answer patient call effectively.
Help us keep track of our patient interactions. While on calls, use your expert listening skills to get to the heart of a patient’s question quickly and document all interactions in real-time.
Ensure patients are equipped with the best advice. Identify and empathetically address patient concerns and, if necessary, escalate appropriately. What You Should Have:
High School Diploma / GED required
1 year of relevant experience (Medicare Part D experience preferred)
General PC knowledge including Microsoft Office
Excellent communication skills (verbal and written)
(QA) Auditor I - Work from home -eviCore
Bluffton, South Carolina, Berkeley, Missouri,West Seneca, New York,
Franklin, Tennessee, Melbourne, Florida, Plainville, Connecticut,
Remote, Work from home, United States Summary:
Responsible for ongoing improvement of quality standards to ensure accuracy and compliance for Claims Operations and Record Maintenance
Audit claims to ensure accuracy, payment and if errors exist, follow established guidelines to correct errors, assess the accuracy and provide feedback
Work with management and staff to establish and maintain audit and quality assurance programs
Assist in maintaining and developing policies and procedures and training documentation for contract administration
Ensure adherence to company guidelines and policies in contract administration and claims processes.
Collaborates with Supervisor and Subject Matter Expert related to claim audits.
Performs other job-related duties or special projects as assigned
Minimum Education, Licensure, and Professional Certification requirement:
An Associate Degree preferred, preferably in a healthcare-related field
Minimum Experience required:
Minimum 1-2 years claims related experience
Minimum 1-year experience working with at least 2 health plans
MC400, ImageOne, Isaac, and Plexis systems experience preferred
This role is Work At Home/Flex which allows most work to be performed at home. Employees must be fully vaccinated if they choose to come onsite.
Work from home, Saint Mary's GA - Express Scripts
***Work From Home - In Georgia and/or live within 100 miles of Saint Mary's, Georgia ***
Here’s a little more on how you’ll make a difference:
Help patients understand their pharmacy benefits better. Use the knowledge you gain from training, your problem-solving skills, and support from your team to answer patient calls effectively.
Help us keep track of our patient interactions. While on calls, use your expert listening skills to get to the heart of a patient’s question quickly and document all interactions in real-time.
Ensure patients are equipped with the best advice. Identify and empathetically address patient concerns and, if necessary, escalate appropriately.
What you should have:
High School Diploma / GED required
1 year of relevant experience
General PC knowledge including Microsoft Office
Excellent communication skills (verbal and written)
Work From Home, TX, IL, NV, AZ, FL, TN, NC, SC - Evicore
The Care Coordinator is responsible for maintaining workflow activities for the Home Health/Durable Medical Equipment/Home Infusion Therapy Network for inbound and outbound communications between eviCore Healthcare stakeholders and external hospitals, physicians and Post-Acute Care Providers.
Minimum Education, Licensure and Professional Certification requirement:
High School graduate with diploma or equivalent.
Associates or Bachelor’s degree preferred
Minimum Experience required (number of years necessary to perform role):
2+ years of experience in a healthcare contact center or customer service required
Medical background with Post-Acute Care experience desired
Experience with insurance products including Managed Care and commercial plans
Status (Full time, Part-time, or PRN): Full time
Various schedules to cover operating hours (7 AM – 7 PM CST)
Maintain flexibility to variations in work volume/work schedule, which sometimes require extended working hours.
Position may require rotating weekend and holiday coverage. Certain postings may require regular weekend coverage based on business and client needs.
The position is remote.
hiring virtually US.
The main purpose of this role is to oversee the day-to-day operations of the entire call center.
Provide strong, dynamic leadership that mentors develops, and guides team members
Develop, implement and maintain effective internal and external Quality Assurance (QA) programs fostering continuous improvement
Proven experience managing metrics, ensuring customer satisfaction, and reporting statistical performance levels related to Call Center
Works closely with VP of HRA Operations to execute the overall vision and strategy of the call center
Develop and maintain effective organization of responsibility, including efficient recruiting, training, coaching, recognition, workflow patterns, performance standards, delineation of duties and responsibilities, staffing levels and supervision
Coordinate analytic, strategic, and technical resources to meet client expectations and ensure satisfaction
Manage and expand client and coworker relationships
Ensure compliance with regulatory agency guidelines and TCPA standards
Identifies trends and assess opportunities to improve processes and execution
Hours: Monday - Friday; 8:00 - 5:00 Central Time Zone
This role is Work At Home which allows most work to be performed at home. Employees MUST be fully vaccinated if they choose to come onsite.
The Senior Claims Representative Cost Avoidance - Pre Pay adheres to the proper application of coding and audit policies in accordance with CMS and Medicare payment methodology and compliance, provider contracts, and internal business rules. The role assists a team that supports transactions and disputes associated with cost avoidance edits.
It also includes working with internal staff and the vendors to resolve and track provider disputes related to cost avoidance, system issues, IT processes, and provider contracts as well as working with external suppliers to increase edits and improve the accuracy of savings & recovery identified.
Works in conjunction with multiple vendor relationships with the ability to handle additional vendors as the Government Business Segment grows.
Assist with implementations related to new vendors for cost avoidance pre-payment/post-payment edits, subrogation
Participate in Implementation of vendor services for new markets or existing Cigna plans
Implement new audits and edits to increase and maximize overall savings
Participates in workgroups to help resolve complex payment issues; involving QNXT/QCARE Configuration, Health Services, Network, and Contracting
Collaborates with counterparts from the Cigna Commercial (ClaimsXten, ClaimCheck, Prepayment editing)
Assists with training of team members and External Vendors
Ability to interpret coding guidelines, CMS regulations, reimbursement, Medicare Claim Processing for accurate application of policy to claim edits and audits
Research coding and fee schedule questions supporting various departments: Network Operations, Provider Contracting and Configuration
Review unsettled provider disputes for compliant and fair outcome utilizing Call Trackers
Participates in the review and approval process of new Medicare coding edits for claims
Assist manager/supervisor with Legal questions, issues related to edits, audits and reimbursement
Review monthly reports from Suppliers; addressing trends, concerns, spikes or actionable items
LOCATION: Work At Home Across the United States
Preferred Location: Work at Home either in Houston, TX or Nashville, TN.
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 is 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-frames.]
( In-office) TX, FL, TN, PA - Accredo-p WAH US
ESSENTIAL FUNCTIONS
Facilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization.
Performs medical /pharmacy benefits verification requiring complex decision skills based on payer and process knowledge resulting in onboarding or no starting specialty patients.
Contacts benefit providers to gather policy benefits/limitations.
Coordinating and ensuring the services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).
Directly interfaces with external clients.
Provide expert assistance to clients on patient status.
Liaison for the company providing referral status reporting.
May negotiate to price for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome.
Handle Escalations.
Use discretion & independent judgment in handling pt or more complex client complaints, escalating as appropriate.
Completes other projects and additional duties as assigned.
MA - Freedom FertilityFreedom Fertility - $1,500 Sign-On Bonus!
Here’s a little more on how you’ll make a difference:
Ensure process efficiency – Work with both patients and physicians to coordinate fertility plans and medications. Own the patient experience through resolving customer issues and ensuring 100% follow-up to customers.
Pay attention to detail – Accurately obtain and enter patient information, including shipping, insurance, and payment information.
Be a team player – Escalate complex claims to Sr. Billing & Reimbursement Specialists for appropriate action.
Why join us?
$1,500 sign-on bonus*
Health coverage effective day 1 (including medical, dental, vision)
Holiday, PTO, and OT pay
401K with company match
Tuition reimbursement
Fun, friendly and unique culture – bring your whole self to work every day!
What you need to do the job:
An empathetic and fun-loving personality with a few good jokes on the ready
High School Diploma or GED required
Excellent customer service, organization, and time management skills
PC skills including knowledge of Microsoft Office Suite and Internet
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.
*Sign-on bonus: 50% paid after 90 days of employment and 50% paid after 180 days of employment.
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
Monthly pay for performance bonus incentive
A clear path for advancement, with eviCore’s CoreMap showing your unique path to
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