Provider Relations & Claims Advocate - Evernorth Behavioral Health - Remote

The Claims & PR (Provider Relations) Advocate will service inbound claim calls from both members and providers or their office support staff.

Occasional outbound calls are required to resolve claim issues.

The types of calls a Claims & PR Advocate services may include but are not limited to: inquiries about claim status details, claim reprocessing or adjustment requests, provider contract questions or requests to update demographics.

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.

Responsibilities:

The primary responsibility of this role is to answer inbound claim calls from members or providers, as well as contracting and Provider Relations-related calls from 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, a Claims & PR Advocate may:


* Assist a member or provider with understanding how a claim has been processed


* Verify claim status for a member or provider


* Educate a member or provider on billing protocols


* Write or correct authorizations to ensure claims are paid correctly


* Send claims for adjustment/reprocessing


* Request duplicate EOBs for a member or provider


* Send a request for a cancelled check copy, to reissue a check, or request a stop pay/do not reissue on a check


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


* Send resources to members and providers via email


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


* Send an Advocate Handoff/Help Request (AHHR) for escalated or complex issues


* Assist providers with contract related inquiries and demographic updates


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

Skills


* Customer Service experience


* Experience in the Evernorth Behavioral Care Specialist/Advocacy role


* Preferably experienced in taking behavioral health claims and provider relations calls.


* Able to excel and/or prior successful experience in a virtual team environment


* Ability to maintain a professional and positive image to members, providers, facilities, billing offices, etc.


* Candidate must possess superb interpersonal communication skills


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


* Intuitive technical capabilities with the ability to quickly understand and apply working knowledge on several claim systems and applications


* Independent problem-solvi...