[Hiring] Evernorth CareNav + Care Guide @The Cigna Group

Role Description

This position supports a resolute team for our clients Evernorth app & Express Scripts Pharmacy inquiries with expanded responsibilities in proactively educating on and recommending a multitude of Evernorth programs and services. The team consists of highly analytical, technical-minded Customer Service experts with depth of knowledge in resolving and navigating within a multifaceted health care setting.

• Provide the highest level of service on inbound member interactions.
• Assist customers with the Evernorth app, including:
  • Helping download, register, and log into the app.
  • Informing of all app features and highlighting navigation steps to find vendor offerings.
  • Educating on Wellness Rewards and value propositions.
  • Troubleshooting app & providing follow-up on tickets submitted for resolution.
• Support member inquiries and needs for their Express Scripts mail order account, including:
  • Eligibility.
  • Benefit quotes.
  • Complex claim resolution or education.
  • Cost savings strategies.
  • Advanced support with prior authorizations.
  • Advanced support on claims rejections & overrides.
• Required to have a strong and thorough understanding of the full suite of Medical & Pharmacy benefits and external vendor offerings.
• Confidently partner with other departments to ensure all members’ needs are met to achieve resolution and recommendations for next steps in their healthcare journey.
• Listen to understand members' unique needs while seeking more information through probing questions.
• Investigate and resolve escalations, barriers to care, and complaints.
• Proactively offer outreaches to pharmacy, doctor, or vendors as needed.
• Take ownership and provide timely follow-up on any takeaway from member interactions.
• May serve as primary contact and liaison between customers, health plans, service centers, and/or functional areas.
• Be a champion of change and adapt well to frequent adjustments to procedures.
• Must be highly coachable and open to feedback to improve member experience.

Qualifications

• High School, GED or higher required and/or 2+ years’ work experience in customer service field.
• Required 1+ years call experience in US Commercial Pharmacy Call Operations background; specifically PBM Commercial trained.
• Ability to actively listen to understand current needs and complexities.
• Excellent written and verbal interpersonal communication skills.
• Adept with KnowledgeXchange & initiative-taking resource utilization.
• Confidence with technology and ability to toggle three or more systems.
• Creative problem-solving and analytical skills with self-awareness of time to resolution.
• Proven record of working independently in a fast-paced, quality-driven environment.
• Proficiency in Outlook and WebEx.

Requirements

• Consistently strong KPI scores over the last 12 months must be meeting or exceeding current targets.
• Quality: ≥95%
• Resolution: ≥90%
• CSAT: ≥4.75
• Caller Effort: ≥85%
• If working at home, internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Benefits

• Hourly rate of 22 - 33 USD / hourly, depending on relevant factors, including experience and geographic location.
• Eligible to participate in an annual bonus plan.
• Comprehensive range of benefits, including medical, vision, dental, and well-being and behavioral health programs.
• 401(k), company paid life insurance, tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.