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Role Description
The Claims & PR Advocate is a phone queue-based position responsible for servicing inbound claim-related calls from members, providers, and provider office staff. Advocates will handle back-to-back calls throughout the day, with occasional outbound calls required to resolve claim issues. This role demands strong multitasking, technical proficiency, and independent problem-solving skills.
• Answer inbound calls from members and providers regarding claims, contracting, and provider relations.
• Work in a structured call queue environment, handling a high volume of calls daily.
• Make outbound calls as needed for issue resolution or follow-up.
• Use multiple applications during calls to research and resolve inquiries.
• Call topics may include:
• Claim status inquiries and explanations
• Requests for claim reprocessing or adjustments
• Provider contract questions and demographic updates
• Authorization corrections to ensure proper claim payment
• Requests for duplicate EOBs or check reissuance
• Escalated issue handling via Advocate Handoff/Help Request (AHHR)
• Complaint submissions on behalf of members or providers
• Emailing resources and documentation to callers
Qualifications
• Bachelor’s degree is required
• Proven customer service experience
• Prior experience in Evernorth Behavioral Care Specialist/Advocacy role preferred
• Experience handling behavioral health claims and provider relations calls is a plus
• Ability to thrive in a virtual team environment
• Strong interpersonal and communication skills
• Effective listening and organizational abilities
• Technical aptitude with multiple systems and applications
• Independent problem-solving and time management skills
• Proficient typing and PC skills
Requirements
• Training Schedule: Monday through Friday, 8:30 AM – 5:00 PM CT
• Work Schedule: After training, shifts are Monday through Friday between 7:00 AM – 7:00 PM CT
• The recruiter will provide specific shift options
• 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.
• Hourly rate of 24 - 36 USD / hourly, depending on relevant factors, including experience and geographic location.
• Eligible to participate in an annual bonus plan.
Benefits
• Comprehensive range of benefits focusing on supporting your whole health
• Health-related benefits including medical, vision, dental, and well-being and behavioral health programs
• 401(k)
• Company paid life insurance
• Tuition reimbursement
• A minimum of 18 days of paid time off per year and paid holidays
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