Customer Service Representative - Cigna Healthcare - Remote

The Cigna Group

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.

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