Provider Relations Associate Analyst

Overview

Please see attached qualifying questions prior to submitting candidates to request.

Please Note:

this position is fully remote / work from home. At this time, candidates must be willing to complete all training and work from their home. Client / Evernorth will supply all equipment, however, high speed internet is required. Candidates must have reliable high speed internet connection at home – this will NOT be provided. Manager seeking candidates located anywhere in the U.S.;

candidates located in PST or MST are ideal to staff our late shift.

Please Note:

hours during training are 9:30 am–6:00 pm CST. After all of the training is completed, the hours for this position will be 10:30 am–7:00 pm CST.

Contractors will initially be trained to take calls regarding Eligibility and Benefits from Behavioral Health Providers. This initial training is required before learning how to service Claim and PR (Provider Relations) calls. Timing for the Claim and PR training is yet to be determined, and will be based on business need.

The Claims & PR (Provider Relations) Advocate will service inbound claim calls from both members and providers or their office support staff. Occasional outbound calls are required to resolve claim issues.

The types of calls a Claims & PR Advocate services may include but are not limited to: inquiries about claim status details, claim reprocessing requests, provider contract questions or requests to update demographics. Due to the wide variety of call types, 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.

• Answer inbound claim calls from members or providers, and contracting and Provider Relations related calls from providers.
• Assist a member or provider with understanding how a claim has processed.
• Verify claim status for a member or provider.
• Educate a member or provider on billing protocols.
• Write or correct authorizations to ensure claims are paid correctly.
• Send claims for adjustment/reprocessing.
• Request duplicate EOBs for a member or provider.
• Send a request for a cancelled check copy, to reissue a check, or request a stop pay/do not reissue on a check.
• Provide follow‑up on issues by making outbound calls when necessary.
• Send resources to members and providers via email.
• Submit a complaint on the member or provider's behalf.
• Send handoff requests to matrix partners for escalated or complex issues.
• Assist providers with contract related inquiries and demographic updates.
• Independently problem‑solve to ensure accurate information is given, exceptional customer service, and first call resolution is achieved.

• Customer Service experience.
• Ability to excel and/or prior successful experience in a virtual team environment.
• Ability to maintain a professional and positive image to members, providers, facilities, billing offices, etc.
• Candidate must possess superb interpersonal communication skills.
• Effective listening and organizational skills, with the ability to manage multiple tasks.
• Intuitive technical capabilities with the ability to quickly understand and apply working knowledge on several claim systems and applications.
• Independent problem‑solving skills.
• Strong time management skills.
• Ability to type effectively and have strong PC skills.

Training hours are Monday through Friday 9:30 am–6:00 pm CST.

After all of the training is completed, the hours for this position will be 10:30 am–7:00 pm CST.

Maintaining good attendance is important for all contractors and is particularly important for those newly hired to the assignment. The Corrective Action process for a contractor who incurs an unscheduled or unapproved absence or event in his/her first 90 days of assignment is outlined below.