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Role Description

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

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.

• 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.
• 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.
• 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.

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.

Company Description

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.