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Case Management Analyst

  • Location

    Eden Prairie, United States

  • Sector:

    Other Area(s)

  • Job type:

    Contract

  • Contact:

    Leric Arcigal

  • Job ref:

    20349

  • Published:

    about 1 year ago

  • Expiry date:

    2020-07-10

  • Please see attached Qualifying Questions for this Req*

Role Summary:

The Personal Advocate position is responsible for representing Cigna Behavioral Health (CBH) to all inbound callers within a call center environment and assuring callers contact with CBH is positive. Advocates are many times the first encounter customers have with Cigna and thus are responsible for giving a positive first impression. The Advocacy tasks of this position are varied and often complex in nature requiring flexibility and multi-tasking capabilities. Responsibilities may include but are not limited to: educating customers on benefits, eligibility, referrals, non-clinical resources and assessing for potential risk of harm or substance abuse concerns. This position services calls in a warm and empathic manner as many of the calls are sensitive in nature. Independent problem solving skills are critical to success within the role along with intelligent judgment of assessing the callers 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 Cigna training to effectively address callers needs in an educational manner. This position is an entry level role with opportunity for growth within the company. Incumbents will utilize telephonic communication the majority 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 customers and providers.

Within a customer call an advocate may:

Register participants in the intake system and opens case files Educate participants on their benefits based upon individual plan design and other clinical or non-clinical resources available Conduct an intake as needed to assess for presenting concern and risk of harm or substance abuse concerns Provide participants with names and phone numbers of nearest providers Multi-task by maneuvering through various computer programs and screens

Within a provider call an advocate may:

Assist with authorization requests for behavioral health services including but not limited to Inpatient, Residential, Partial Hospitalization, and Outpatient care Assess criteria for authorizing initial days or handing off to a care manager to make determinations

Educate providers on authorization requirements or confirming authorizations on file in support of claims payment.

On all calls an advocate is responsible for:

Providing high quality customer service as identified by 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 (?)- Wording. Should it match the verbiage above (Advocacy department quality standards ) Taking an educational approach to ensure callers are able to understand the complexities of accessing care Demonstrating a complete awareness and understanding of the responsibilities and workflows of the various departments within Cigna