Customer Service Representative - Cigna Healthcare - Remote

Cigna Healthcare is an advocate for better health through every stage of life, guiding customers through the health care system. They are seeking a Customer Service Representative who will coordinate provider phone calls related to pre-treatment review status and Case Management call coordination, while performing customer service-related duties for the ACM team.

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
• Consistently meet or exceed company standards for production, quality, and audit performance

Requirements:

• High school graduation or GED required
• Excellent oral and written communication skills required
• Basic computer and customer service 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
• Bachelor's Degree preferred
• Medical terminology and medical coding experience preferred