Customer Service Representative - Cigna Healthcare - Remote

Cigna Healthcare

1d•Remote

About The Position

The UM CSR is responsible for the coordination and collaboration of provider phone calls related to pre-treatment review status and Case Management call coordination. The UM CSR will perform all customer service-related duties of the ACM team related to service/authorization requests and Case Management call coordination, responding promptly to all calls. About Allegiance by Cigna Healthcare Since 1981, Allegiance by Cigna Healthcare has specialized in administering medical benefits, including claims processing, customer service, utilization management, and case management. With a high‑touch approach to member and client service, Allegiance supports some of the nation’s most innovative health benefit strategies. 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. About Cigna Healthcare Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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 [email protected] 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. Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Requirements

High school graduation or GED required
Basic computer and customer service required
Excellent oral and written communication skills required
PC skills, including Windows and Word
Must be able to adapt to software changes as they occur
Good interpersonal skills, works effectively with others
Ability to organize and recall large amounts of detailed information
Ability to read, analyze and interpret benefit summary plan descriptions, insurance documents, plan benefits, and regulations and make appropriate applications to specific situations
Ability to identify errors/oversights and make corrections
Ability to project a professional image and positive attitude in any work environment
Ability to comply with privacy and confidentiality standards
Ability to be flexible, work under pressure, meet deadlines
Ability to analyze and solve problems with professionalism and patience, and to exercise good judgment when making decisions
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.

Nice To Haves

Bachelor’s Degree preferred
Medical terminology and medical coding experience preferred

Responsibilities

Answers telephone calls pertaining to pre-treatment review status
Answers telephone calls pertaining to Case Management services and directs appropriately
Provides clear and accurate responses to requests for information
Documents all calls in Case Management platform for future referral
Returns messages left in designated voice mailboxes
Reads and interpreters plan documentation language pertaining to review requirements
Meets or exceeds company standards for production and quality
Contributes to the daily workflow with regular and punctual attendance
Follows up with callers when research is needed to provide an accurate answer to the caller’s question
Communicate with provider when and what specific additional information is needed to complete a review
Distribute medical review response letters via fax as requested
Initiates referrals for Case Management when appropriate
When necessary, verifies request CPT/ICD codes, and utilizes the CPT database to determine if review is recommended
Promotes the use of ACMs (Allegiance Care Management) external self-service tools to eliminate unnecessary calls
Assists in managing incoming fax queue as necessary
Contributes to the daily workflow with regular and punctual attendance
Quality Assurance Measurements Consistently meet or exceed company standards for production, quality, and audit performance