Customer Service Representative - Cigna Healthcare - Remote

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.

ESSENTIAL JOB FUNCTIONS:

• 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

Quality Assurance Measurements

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

Minimum Education:
High school graduation or GED required. Bachelor’s Degree preferred

Minimum Experience:
Basic computer and customer service required. Medical terminology and medical coding experience preferred

Other Qualifications:

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.

About Allegiance by Cigna Healthcare

Since 1981, Allegiance by Cigna Healthcare has specialized in administering medical benefits, including claims processing, customer service, utilization management, and case management. With a high‑touch approach to member and client service, Allegiance supports some of the nation’s most innovative health benefit strategies.

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 Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

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.