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.
Note: This position requires a Bachelor's degree to qualify.
Key Responsibilities:
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
Required Skills:
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
Training Schedule:
Work Schedule:
After training, shifts are Monday through Friday between 7:00 AM - 7:00 PM CT
The recruiter will provide specific shift options
Education Requirement:
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.
For this position, we anticipate offering an hourly rate of 24 - 37 USD / hourly, depending on relevant factors, including experience and geographic location.
This role is also anticipated to be eligible to participate in an annual bonus plan.
At The Cigna Group, you'll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you'll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here (https://jobs.thecignagroup.com/us/en/benefits) .
About Evernorth Health Services
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
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.