Qureos Mentor

Cigna Healthcare

<div>
 
 The hours of this role will fall between 8am-9pmEST Mon-Fri.
 
 
 
 
 Position Summary
 
 
 
 Highly technical Customer Service expert with depth of knowledge within a health care setting. This position will require highly analytical, advanced ability to connect with the member, with a depth of knowledge in resolving and navigating within a health care setting. This position supports medical health plan clients with benefit needs and will also have the expanded responsibility of recommending vendor programs and services. Although this position is within a call center, it differs from typical call center roles due to the requirement and ability to independently seek solutions to customer needs. Candidates must have a proven track record in resolving claims issues, navigating complex health conditions and be the embodiment of empathy as their key driver in member experience. Possesses relationship building behaviors including, but not limited to: empathy, curiosity and helpfulness. Ability to demonstrate active listening, critical thinking, building rapport and being proactive. Clearly demonstrates application of resources and support to provide solutions to customer. Ideal candidates must have the ability to listen intently to what is being shared by the customer to recommend medical benefit and vendor offerings that will achieve optimal emotional, financial and physical health outcomes. Takes ownership for customer&rsquo;s inquiry and follows through to completion, removing the customer &ldquo;from the middle&rdquo;. This position must think and perform more critically, leveraging their call center experience, creative thinking, and keen problem solving skills to take their service in this role to the next level. The ability to operate in the absence of precise work instructions is critical for success.
 
 
 
 This Position Will Have The Following Multifaceted Responsibilities
 
 
 
 <ul>
 <li>
 Responsible for providing high level of service to inbound calls, outbound calls, direct messaging and digital chat customers with more complex medical conditions and/or needs.
 </li>
 <li>
 Will educate customer on Medical health plan benefit package and vendors to enable optimal health outcomes.
 </li>
 <li>
 Conducts in-network provider searches and facilitates appointment scheduling.
 </li>
 <li>
 Provides advanced support with prior authorizations, helping to navigate next steps on denials and/or missing information.
 </li>
 <li>
 Investigates and resolves escalations, issues, complaints obtaining necessary information from policies, procedures, or practices. When knowledge articles are not available to guide next steps, must be able to autonomously and accurately determine the best solution or option for customer.
 </li>
 <li>
 Highly organized with ability to follow-up timely and communicate proactively to customer and other necessary parties.
 </li>
 <li>
 May serve as primary contact and liaison between customers, health plans, service centers, and/or functional areas.
 </li>
 <li>
 Must have thorough technical knowledge of assigned products and excellent communication skills.
 </li>
 <li>
 Understands when to seek support by coaches and leadership for issue resolution.
 </li>
 <li>
 Requires the delivery of complex business resolution services in customer service via inbound calls, outbound calls and portal messaging to customers.
 </li>
 <li>
 Responds to inquiries from policy holders where additional information or research is needed.
 </li>
 <li>
 Must listen intently and have ability to interpret verbal cues from customers, using technical expertise and breadth of knowledge to determine most effective action or response.
 </li>
 <li>
 The position requires high level of compassion and empathy, excellent interpersonal skills, strong communication and comfortability in sharing intricate and/or difficult messages.
 </li>
 <li>
 Knowledge and understanding of Customer Service and business/operating processes and procedures required.
 </li>
 <li>
 Must be a champion of change and adapt well to frequent adjustments to procedures or guidance.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 High School diploma or GED required.
 </li>
 <li>
 Required experience in US Commercial Medical Call Operations Background:
 </li>
 <li>
 Proclaim
 </li>
 <li>
 CCF / CDHP skillset
 </li>
 <li>
 Medical OneGuide
 </li>
 <li>
 OneView
 </li>
 <li>
 Proven ability to listen, understand customers current &amp; future needs, and interpret information from others
 </li>
 <li>
 Excellent communication skills in the spoken and written word
 </li>
 <li>
 Creative problem-solving and analytical skills
 </li>
 <li>
 Proven ability to independently manage day in a fast-paced environment
 </li>
 <li>
 Proficiency in Word and Outlook
 
 
 </li>
 </ul>
 
 Performance Requirements
 
 
 
 <ul>
 <li>
 Strong KPI scores over the last 12 months; must be meeting or exceeding current targets
 </li>
 <li>
 &ge;90% in Quality
 </li>
 <li>
 &ge;90% in Contact Resolution
 </li>
 <li>
 Meeting Overall Agent Survey Result (target varied by team)
 
 
 </li>
 </ul>
 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.
 
 
 
 About The Cigna Group
 
 
 
 Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we&rsquo;re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
 
 
 
 Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
 
 
 
 
 If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
 
 
 
 
 The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
 
 
 
 
 Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
 
</div>

Navigation- Step Up- Service Advocate - Cigna Healthcare - Remote

<div>
 The Claims Examiner is responsible for the accurate and timely processing of medical, dental, vision and prescription drug claims. The incumbent is expected to provide courteous and prompt responses to customer inquiries.
 
 
 The incumbent is expected to communicate professionally with peers, supervisors, subordinates, vendors, customers, and the public, and to be respectful and courteous in the conduct of this position.
 
 
 
 Essential Job Functions
 
 
 
 <ul>
 <li>
 Essential job functions include the following. Other functions may be assigned as business conditions change.
 </li>
 <li>
 Verifies the accuracy and receipt of all required documentation for each claim submitted.
 </li>
 <li>
 Collaborates with providers, plan participants, other claims payers, or any other party necessary to obtain information necessary to accurately process a claim.
 </li>
 <li>
 Analyzes information necessary for processing. This includes, but is not limited to, general participant and provider information, managed care affiliation, diagnosis codes, dates, place, type of service, procedure codes, and charges.
 </li>
 <li>
 Assures that the system processes the claim correctly and determines payment according to the plan as written.
 </li>
 <li>
 Word-processes correspondence to plan participants and providers in reference to pre-determinations and in response to basic benefit questions.
 </li>
 <li>
 Answers telephone calls from plan participants, group contacts, and customer service representatives pertaining to benefits and claims inquiries.
 </li>
 <li>
 Resolves problematic claims with the assistance of the Team Leader, Claims Manager and/or the Director of Claims.
 </li>
 <li>
 Assigns critically ill patients to large case management. Assists the case manager with direct negotiation and the efficient use of benefits.
 </li>
 <li>
 Assists other examiners as needed due to workload requirements, including assigned back-up when examiners are absent.
 </li>
 <li>
 Aids the Team Leader and/or the Claims Manager in the resolution of claim appeals and disputes by providing documentation for review.
 </li>
 <li>
 Researches, calculates and requests refunds when necessary.
 </li>
 <li>
 Contributes to the daily workflow with regular and punctual attendance.
 </li>
 <li>
 Thoroughly researches and completes renewal reports in a timely manner in consultation with the Marketing Department.
 </li>
 <li>
 Process eligible claims on groups before the end of their stoploss contract renewal period.
 </li>
 <li>
 Assists the Legal Department with subrogation claims as necessary.
 </li>
 <li>
 Attends various group meetings as required.
 </li>
 <li>
 Assists with audits as needed.
 </li>
 <li>
 Assists with plan benefit set-up and changes as needed.
 
 
 </li>
 </ul>
 
 Minimum Education
 
 
 
 High school graduation or GED required.
 
 
 
 Minimum Experience
 
 
 
 Basic computer and customer service experience required.
 
 
 
 Other Qualifications
 
 
 
 <ul>
 <li>
 Excellent oral and written communication skills required.
 </li>
 <li>
 PC skills, including Windows and Word.
 </li>
 <li>
 Ability to learn all functions of the claims processing software as is necessary for claims processing and adjudication.
 </li>
 <li>
 Must be able to adapt to software changes as they occur.
 </li>
 <li>
 Typing ability of 45 wpm net
 </li>
 <li>
 Excellent listening skills.
 </li>
 <li>
 Basic mathematical skills.
 </li>
 <li>
 High level of interpersonal skills to work effectively with others.
 </li>
 <li>
 Ability to organize and recall large amounts of detailed information.
 </li>
 <li>
 Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations and make appropriate applications to specific situations.
 </li>
 <li>
 Ability to meet productivity standards with 99% financial accuracy and 95% procedural accuracy.
 </li>
 <li>
 Thorough knowledge of claims processing procedures and requirements.
 </li>
 <li>
 Ability to project a professional image and positive attitude in any work environment.
 </li>
 <li>
 Ability to comply with privacy and confidentiality standards.
 </li>
 <li>
 Ability to be flexible, work under pressure and meet deadlines.
 </li>
 <li>
 Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions.
 </li>
 <li>
 Ability to operate typical office equipment.
 </li>
 <li>
 Working knowledge of general office procedures.
 
 
 </li>
 </ul>
 
 About Allegiance By Cigna Healthcare
 
 
 
 
 Since 1981, Allegiance by Cigna Healthcare has specialized in administering medical benefits, including claims processing, customer service, utilization management, and case management. With a high‑touch approach to member and client service, Allegiance supports some of the nation&rsquo;s most innovative health benefit strategies.
 
 
 
 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.
 
 
 
 About Cigna Healthcare
 
 
 
 Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
 
 
 
 Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
 
 
 
 
 If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
 
 
 
 
 The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
 
 
 
 
 Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
 
</div>

Health Claims Examiner - Cigna Healthcare - Remote

<div>
 
 
 This position provides essential support for both the billing and accounting functions at Allegiance. For billing, responsibilities include gathering rate information to prepare monthly health group billing and premium statements, ensuring timely facilitation of fixed cost payments. The incumbent will also carry out general accounting duties, such as reporting, reconciliations, and data entry.
 
 
 
 
 Billing Responsibilities
 
 
 The Enrollment &amp; Billing Representative prepares monthly health billing statements for client groups. Verifies the accuracy of enrollment information for each group billed. Compares and verifies the accuracy of billing rates to information contained in each groups&rsquo; ASA. Gathers data from brokers or marketing staff to set new, renewal, or revised group rates. Relays relevant renewal information to the appropriate Enrollment Specialist as it is accumulated. Prepare premium statements and check requests based on billing information. Compiles various spreadsheet reports pertaining to billing and rates as requested; creates invoices for special circumstances as required. Resolves problems by collaborating with Flex Bookkeepers, Enrollment Specialists, Accountants, marketing personnel, and brokers. Answers telephone calls and email questions from clients and brokers. Tests health billing functions for software updates. Contributes to the daily workflow with regular and punctual attendance. Ability to multi-task.
 
 
 Accounting Responsibilities
 
 
 The Enrollment &amp; Billing Representative updates accounting reports and emails to Allegiance personnel. Completes monthly reporting for Flex Department in collaboration with Staff Accountants.
 
 
 <ul>
 <li>
 Minimum Education: High school graduation or GED required.
 </li>
 <li>
 Minimum Experience: Experience with computers required; accounting or bookkeeping experience preferred.
 
 
 </li>
 </ul>
 
 Other Qualifications
 
 
 
 <ul>
 <li>
 Excellent oral and written communication skills required.
 </li>
 <li>
 PC skills including Windows, Word, Excel, Access, internet, and email applications.
 </li>
 <li>
 Must be able to adapt to software changes as they occur.
 </li>
 <li>
 Ability to learn all functions of the claims processing software program necessary for billing and adapt to software changes as needed.
 </li>
 <li>
 Ability to enter data accurately and precisely.
 </li>
 <li>
 Basic accounting and mathematical skills.
 </li>
 <li>
 High level of interpersonal skills to work effectively with others.
 </li>
 <li>
 Ability to organize and recall large amounts of information, including interactions with employees, agents, plan participants, and clients.
 </li>
 <li>
 Ability to project a professional image and positive attitude in any work environment.
 </li>
 <li>
 Ability to comply with privacy and confidentiality standards.
 </li>
 <li>
 Ability to analyze and solve problems with professionalism and patience, exercising good judgment when making decisions.
 </li>
 <li>
 Ability to operate typical office equipment.
 </li>
 <li>
 Working knowledge of general office procedures.
 
 
 </li>
 </ul>
 
 About Allegiance By Cigna Healthcare
 
 
 
 
 
 Since 1981, Allegiance by Cigna Healthcare has specialized in administering medical benefits, including claims processing, customer service, utilization management, and case management. With a high‑touch approach to member and client service, Allegiance supports some of the nation&rsquo;s most innovative health benefit strategies.
 
 
 
 
 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.
 
 
 
 About Cigna Healthcare
 
 
 
 Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.
 
 
 
 Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
 
 
 
 
 If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.
 
 
 
 
 The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
 
 
 
 
 Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
 
</div>

Enrollment/Billing Representative - Cigna Healthcare - Remote

Join Cigna Healthcare and explore 3   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Cigna Healthcare

About Company

Navigation- Step Up- Service Advocate - Cigna Healthcare - Remote

Health Claims Examiner - Cigna Healthcare - Remote

Enrollment/Billing Representative - Cigna Healthcare - Remote