Job Description
This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. 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 • Bachelor’s degree is required • 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 • Training Schedule: Monday through Friday, 8:30 AM – 5:00 PM CT • Work Schedule: After training, shifts are Monday through Friday between 7:00 AM – 7:00 PM CT • The recruiter will provide specific shift options • 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. • Hourly rate of 24 - 36 USD / hourly, depending on relevant factors, including experience and geographic location. • Eligible to participate in an annual bonus plan. Benefits • Comprehensive range of benefits focusing on supporting your whole health • Health-related 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 Apply tot his job