Claims Research Rep - eviCore - Remote

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Smoking cessation program
• Tuition reimbursement
• Vision insurance

eviCore is currently hiring four Claims Research Representatives. The Rep performs research to respond to inquiries and interprets policy provisions to determine most effective response. Mails or routes claim forms and supporting documentation to various units for final processing. Position typically requires excellent interpersonal skills, ability to understand and interpret policy provisions. Independently responds to inquiries, grievances or complaints of moderate to substantial complexity. Completes day-to-day tasks without immediate supervision but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members. Work Shift : Monday - Friday 9:30a - 6p CST

RESPONSIBILITIES:
Maintain the Claims’ phone queue by providing great customer service to all callers regarding billed claims, denied claims or pended claims.

Understand the processes involved in the adjudication of a claim.

Investigate and resolve issues for providers.

Escalate concerns, claim issues or payment errors to the appropriate team for handling.

Cross-train on other administrative duties as needed.

QUALIFICATIONS:
High School graduate with diploma or GED

Minimum 6 months experience in call center and/or claims operation

Previous patient eligibility/benefits experience preferred

Must be in good standing with the Company

Exceptional communication skills (verbal and written) required

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 17 - 18 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.

We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group .

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 require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] 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.