Case Management Lead Representative - Remote

Case Management Lead Rep - Benefits & EAP Advocate

The Advocate role is a non-clinical customer service position within an inbound call center that supports Evernorth Behavioral Health.

Advocates are responsible for handling inbound calls from both members and providers or their office support staff regarding mental health or substance use disorder services.

Advocates guide and assist the members and providers to help them work with Cigna/Evernorth more effectively and ensure first call resolution.

The types of calls an Advocate service may include but are not limited to: triaging and assessing the need for clinical intervention, inquiries about provider referrals and access to care, eligibility, and benefits.

Due to the wide variety of call types, several applications are required to service these inquiries, and multiple applications are often needed within the same call.

Independent problem solving, multitasking, and technical savvy are essential in order to be able to carry out the responsibilities of this role.

Calls must be serviced in a helpful and professional manner.

The nature of discussions within the Behavioral Advocate role often delve into personal and sensitive topics with members.

It demands a nuanced understanding of mental health and substance use issues.

This role differs from its medical counterpart in that mental health is a sensitive subject and staff are helping members navigate complex and emotional mental health challenges.

Responsibilities:

The primary responsibility of this role is to answer inbound calls from members and providers.

The work environment is structured, and the majority of the day will be spent answering these calls from a queue.

Occasional outbound calls may be necessary for issues requiring follow-up.

Within a call an Advocate may:


* Use active listening and empathy skills to triage and assess for risk of harm and substance use concerns


* Coordinate with multiple matrix partners, and facilitate seamless hand offs to clinical partners for timely support


* Communicate eligibility, generate a list of provider referrals, quote benefits, or advise of authorization requirements for services


* Write authorizations to ensure claims are paid correctly


* Provide follow-up on issues by making outbound calls when necessary


* Send resources to members and providers via email


* Submit a complaint on the members or provider's behalf


* Independently problem-solve to ensure accurate information is given, and exceptional customer service and first call resolution is achieved

Skills


* Customer Service experience


* Prior experience working in a patient focused mental health environment preferred


* Ability to maintain a professional and positive image to external customers


* Candidate must possess superb interpersonal communication skills


* Effective listening and organizational skills, with the ability to manage multiple tasks


* Intuitive techni...