Job Description

The hours of this role will fall between 8am-9pmEST Mon-Fri.

Position Summary

Highly technical Customer Service expert with depth of knowledge within a health care setting. This position will require highly analytical, advanced ability to connect with the member, with a depth of knowledge in resolving and navigating within a health care setting. This position supports medical health plan clients with benefit needs and will also have the expanded responsibility of recommending vendor programs and services. Although this position is within a call center, it differs from typical call center roles due to the requirement and ability to independently seek solutions to customer needs. Candidates must have a proven track record in resolving claims issues, navigating complex health conditions and be the embodiment of empathy as their key driver in member experience. Possesses relationship building behaviors including, but not limited to: empathy, curiosity and helpfulness. Ability to demonstrate active listening, critical thinking, building rapport and being proactive. Clearly demonstrates application of resources and support to provide solutions to customer. Ideal candidates must have the ability to listen intently to what is being shared by the customer to recommend medical benefit and vendor offerings that will achieve optimal emotional, financial and physical health outcomes. Takes ownership for customer’s inquiry and follows through to completion, removing the customer “from the middle”. This position must think and perform more critically, leveraging their call center experience, creative thinking, and keen problem solving skills to take their service in this role to the next level. The ability to operate in the absence of precise work instructions is critical for success.

This Position Will Have The Following Multifaceted Responsibilities

• Responsible for providing high level of service to inbound calls, outbound calls, direct messaging and digital chat customers with more complex medical conditions and/or needs.
• Will educate customer on Medical health plan benefit package and vendors to enable optimal health outcomes.
• Conducts in-network provider searches and facilitates appointment scheduling.
• Provides advanced support with prior authorizations, helping to navigate next steps on denials and/or missing information.
• Investigates and resolves escalations, issues, complaints obtaining necessary information from policies, procedures, or practices. When knowledge articles are not available to guide next steps, must be able to autonomously and accurately determine the best solution or option for customer.
• Highly organized with ability to follow-up timely and communicate proactively to customer and other necessary parties.
• May serve as primary contact and liaison between customers, health plans, service centers, and/or functional areas.
• Must have thorough technical knowledge of assigned products and excellent communication skills.
• Understands when to seek support by coaches and leadership for issue resolution.
• Requires the delivery of complex business resolution services in customer service via inbound calls, outbound calls and portal messaging to customers.
• Responds to inquiries from policy holders where additional information or research is needed.
• Must listen intently and have ability to interpret verbal cues from customers, using technical expertise and breadth of knowledge to determine most effective action or response.
• The position requires high level of compassion and empathy, excellent interpersonal skills, strong communication and comfortability in sharing intricate and/or difficult messages.
• Knowledge and understanding of Customer Service and business/operating processes and procedures required.
• Must be a champion of change and adapt well to frequent adjustments to procedures or guidance.

Qualifications

• High School diploma or GED required.
• Required experience in US Commercial Medical Call Operations Background:
• Proclaim
• CCF / CDHP skillset
• Medical OneGuide
• OneView
• Proven ability to listen, understand customers current & future needs, and interpret information from others
• Excellent communication skills in the spoken and written word
• Creative problem-solving and analytical skills
• Proven ability to independently manage day in a fast-paced environment
• Proficiency in Word and Outlook

Performance Requirements

• Strong KPI scores over the last 12 months; must be meeting or exceeding current targets
• ≥90% in Quality
• ≥90% in Contact Resolution
• Meeting Overall Agent Survey Result (target varied by team)

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 The Cigna Group

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.

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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Job Tags

Full time, Local area, Remote work, Work from home

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