Medicare Complaints (CTM) Lead Representative - Cigna Healthcare - Remote

Position Summary:

• Responsible researching and resolving complex and/or escalated member/provider issues received from CMS (CTM complaints), Department of Insurance (DOI), Congressional offices, and escalated executive level inquires, etc.

• Conducts a thorough investigation of complaints (CTMs) and escalated inquiries to accurately resolve the issues at hand and prevent future complaints from occurring.

• Responsible for assigned caseload which requires timely follow up to ensure completion of cases within tight frames in order to meet internal and CMS expected goals.•

• Demonstrates the ability to problem solve, identify root causes and make the proper recommendations to correct the root cause of the issue/complaint.

• Makes outbound calls to gather information and/or communicate the resolution to the appropriated party regarding the member/provider complaint.

• Creates written correspondence letters to provide resolution to complaints when verbal contact cannot be made with the complainant.

• Documents all case research notes and resolution actions, in the appropriate systems, within the required time frames.

• Communicates with other departments, when necessary, to resolve member/provider issues.

• Knows the formal and informal departmental goals, standards, policies and procedures, which includes familiarity of other departments within the organization that allows him/her to identify workflow efficiencies and process improvements across the organization.

• Displays a positive attitude and reports problems and issues to management as appropriate.

• Handles other duties and special projects as assigned, such as the Customer Advocacy Support Team, (CAST) project.

Qualifications:

• High School Diploma required

• At least 2-5 years experience in Call Center Service.

• Knowledgeable in Medicare Part B, D, & C

• Demonstrated communication skills.

• Strong experience in the areas of customer service.

• Proficient in Microsoft Office including Outlook, Word, Excel, and PowerPoint.

• Excellent verbal and written communication skills, as well as, listening and conflict resolution skills.

• Ability to affectively adapt and respond in a complex, fast-paced, high volume environment.

• Ability to maintain positive/productive relationships.

• Ability to exercise administrative judgment and assumes responsibility for decisions, consequences, and results that have an impact on people, costs, and/or quality of service within the functional area.

• Basic understanding of managed care and its place in the health care industry.

• Highly organized and can work independently.

• Strong interpersonal skills and the ability to communicate with many different levels of staff.

• Ability to identify and analyze problems and recommend solutions. Proficiency with analytical tools, knowledge of data analysis methodology, strong communication skills and strong commitment to and affinity for delivering the highest level of customer service.​

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.

For this position, we anticipate offering an hourly rate of 21 - 31 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit