[Hiring] Provider Relations & Claims Advocate @The Cigna Group

Role Description

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.

• 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

Qualifications

• 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

Requirements

• Bachelor’s degree is required
• If you will be working at home occasionally or permanently, the 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

• Comprehensive range of health-related benefits including medical, vision, dental, and well-being and behavioral health programs.
• 401(k) plan
• Company paid life insurance
• Tuition reimbursement
• A minimum of 18 days of paid time off per year
• Paid holidays and leaves of absence
• Eligible to participate in an annual bonus plan