Behavioral Health Member Advocate, Dedicated Line (Masters Degree) - Call Center - Remote

The Personal Advocate role is a non-clinical customer service position within an inbound call center that supports Evernorth Behavioral Health. Advocates are responsible for handling inbound calls from both members and providers or their office support staff regarding mental health or substance use disorder services. Advocates guide and assist the members and providers to help them work with Cigna/Evernorth more effectively and ensure first-call resolution.   

The types of calls an Advocate supports include but are not limited to triaging and assessing the need for clinical intervention, inquiries about provider referrals and access to care, eligibility, and benefits. Due to the wide variety of call types and customers (both members and providers), several applications are required to service these inquiries, and multiple applications are often needed within the same call. Independent problem solving, multitasking, and technical savvy are essential to be able to carry out the responsibilities of this role. Calls must be serviced in a helpful and professional manner.

This position services calls in a warm and empathetic manner as many of the calls often delve into personal and sensitive topics with members. It demands a nuanced understanding of mental health and substance use issues. This role differs from its medical counterpart in that mental health is a sensitive subject and staff are helping members navigate complex and emotional mental health challenges.

Independent problem-solving skills are critical to success within the role along with intelligent judgment of assessing the caller’s needs. Based upon the call type and requests, advocates should be able to use customer service skills, knowledge of the mental health/substance abuse field, and Evernorth training, which includes account-specific cultural training, to effectively address callers needs in an educational manner. Additionally, this role requires a focus on claims. The advocate will need to assist customers looking to understand how their benefits were applied to their claims. This position is an entry level role with opportunity for growth within the company. Incumbents will utilize telephonic communication most of the time with some web and internal CBH materials to achieve first time resolution for callers.

Responsibilities:

The primary responsibility of the Advocate role is answering calls from members and providers. The work environment is structured, and the majority of the day will be spent answering these calls from a queue.

On all calls an advocate is responsible for:

• Providing high-quality customer service as identified by the Advocacy department quality standards
• Using independent problem-solving skills to make sound decisions in assessing the needs of the callers by giving accurate information and providing first-call resolution
• Understanding the business needs of the role, while balancing the needs of the customer
• Taking an educational approach to ensure callers can understand the complexities of accessing care
• Demonstrating a complete awareness and understanding of the responsibilities and workflows of the various departments within Cigna as well as connecting with multiple external vendors and matrix partners

As needed an advocate may also:

• Write authorizations to ensure claims are paid correctly
• Send eligibility requests to determine effective coverage dates or to verify correct benefits are loaded
• Send complaints to initiate grievance process for customers
• Provide follow-up on issues by making outbound calls when necessary
• Work with account-specific VIP’s to ensure appropriate support for participants
• Complete scheduling at onsite clinics for participants
• Provides customers with a clear understanding of how their claims have been processed
• Provider start-to-finish case ownership with claims by:
• Supporting complex case completion and appropriate resolution achieved through any necessary communication
• Working with claims examiners to determine appropriate steps in resolution
• Communicating with health care professionals to clarify and resolve claims issues impacting the member and provider
• Reprocessing claims

TRAINING

Initial training for this position will be focused on member calls regarding triage, referrals, benefits, eligibility, and other support resources. Additional train