Provider Relations & Claims Advocate
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Job Description
Provider Relations & Claims Advocate handling inbound behavioral health claims calls for Evernorth Health Services. Resolving provider and member issues through claims research, adjustments, authorizations, and follow-up.
Responsibilities:
- Answer inbound calls from members and providers regarding claims, contracting, and provider relations
- Handle a high volume of back-to-back calls in a structured phone queue
- Make outbound calls for issue resolution and follow-up
- Use multiple applications to research and resolve inquiries
- Handle claim status inquiries and explanations
- Process requests for claim reprocessing or adjustments
- Address provider contract questions and demographic updates
- Correct authorizations to ensure proper claim payment
- Process duplicate EOB and check reissuance requests
- Handle escalated issues through Advocate Handoff/Help Request (AHHR)
- Submit complaints on behalf of members or providers
- Email resources and documentation to callers
Requirements:
- Bachelor’s degree is required
- 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
- Availability for Monday–Friday training, 8:30 AM–5:00 PM CT
- Availability after training for Monday–Friday shifts between 7:00 AM–7:00 PM CT
- Cable broadband or fiber optic internet with at least 10 Mbps download/5 Mbps upload for home work
Benefits:
- Annual bonus plan eligibility
- Medical benefits
- Vision benefits
- Dental benefits
- Well-being and behavioral health programs
- 401(k)
- Company-paid life insurance
- Tuition reimbursement
- Minimum of 18 days of paid time off per year
- Paid holidays
- Leaves of absence
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