The Claims & PR Advocate is a phone queue-based position responsible for servicing inbound claim-related calls from members, providers, and provider office staff. Advocates will handle back-to-back calls throughout the day, with occasional outbound calls required to resolve claim issues. This role demands strong multitasking, technical proficiency, and independent problem-solving skills. Note: This position requires a Bachelor’s degree to qualify. Key Responsibilities: - Answer inbound calls from members and providers regarding claims, contracting, and provider relations. - Work in a structured call queue environment, handling a high volume of calls daily. - Make outbound calls as needed for issue resolution or follow-up. - Use multiple applications during calls to research and resolve inquiries. Call topics may include: - Claim status inquiries and explanations - Requests for claim reprocessing or adjustments - Provider contract questions and demographic updates - Authorization corrections to ensure proper claim payment - Requests for duplicate EOBs or check reissuance - Escalated issue handling via Advocate Handoff/Help Request (AHHR) - Complaint submissions on behalf of members or providers - Emailing resources and documentation to callers Required Skills: - Proven customer service experience - Prior experience in Evernorth Behavioral Care Specialist/Advocacy role preferred - Experience handling behavioral health claims and provider relations calls is a plus - Ability to thrive in a virtual team environment - Strong interpersonal and communication skills - Effective listening and organizational abilities - Technical aptitude with multiple systems and applications - Independent problem-solving and time management skills - Proficient typing and PC skills Training Schedule: - Monday through Friday, 8:30 AM – 5:00 PM CT Work Schedule: - After training, shifts are Monday through Friday between 7:00 AM – 7:00 PM CT - The recruiter will provide specific shift options Education Requirement: - Bachelor’s degree is required 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 24 - 37 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. At The Cigna Group, 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), 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, click here. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. 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.

You could be the one who changes everything for our 28 million members as a Customer Care professional at Centene. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. This is a remote position and the available hours are between 8:00am and 7:00pm CST, Monday - Friday. Position Purpose: Delivers education and information to members and/or providers on behalf of the customer service team to help inform them of the latest updates or changes made to products, gather information, and ensure a successful experience. Facilitates the reach outs via outbound calls to provide providers with timely, accurate, and personalized support. - Reaches out to members and/or providers for educational or informational purposes to help support solutions or concerns - Escalates calls in the event providers are unable to deliver solutions - Serves as the front-line support on various member and/or provider inquiries, requests, or concerns - Assists with sharing product awareness campaigns, policy changes, directory audits, monthly provider satisfaction surveys, and basic claims related outreach with providers - Maintains performance and quality standards based on established contact center metrics - Expands knowledge on primary market and/or plan, and may expand to cover additional markets and/or plans that may require minor research (e.g., benefits eligibility) - Documents information including demographics, call summaries, and communications for quality and performance tracking through the Customer Relationship Management (CRM) applications - Remains up-to-date and adheres to quality standards, regulation, and all other policies to ensure quality, consistency, and compliance - Performs other duties as assigned - Complies with all policies and standards Education/Experience: Requires a High School diploma or GED. Requires 1 – 2 years of related experience. May require vocational or technical education in addition to prior work experience. Vocation or technical education may include additional on-the-job training or continuous learning education. Experience in a contact center environment preferred. Pay Range: $17.84 - $28.02 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

The primary purpose of this role is to coordinate Fast Cert initial and concurrent authorizations for providers across the Proclaim, Facets, and DG books of business on the Autism Care Coordinator Team (ACCT). Autism Care Coordinators communicate with individual and clinic providers regarding authorization requests for Applied Behavioral Analysis (ABA) services on behalf of our customers. This role also monitors an inbound call queue to respond to authorization inquiries and status verifications from providers. Employees in this role are expected to deliver exceptional customer service and collaborate closely with Autism Care Coordinators, Care Managers, facilities, and individual providers to ensure appropriate access to and utilization of benefits. Key Responsibilities - Process electronic authorization requests - Answer and assist provider calls for Cigna Behavioral Health - Validate HIPAA compliance, verify eligibility and benefits, and complete authorization and handoff processes - Utilize established workflows to make efficient, accurate non-clinical decisions based on Fast Cert Authorization criteria - Complete authorization and/or handoff processes in accordance with guidelines - Support a holistic approach to case management, including meaningful engagement, aftercare follow-up planning, and coordination with matrix partners - Research and resolve complex cases, including eligibility issues and escalations - Participate in assigned work groups and stretch assignment opportunities - Attend and actively participate in team meetings Requirements - Bachelor’s degree and a minimum of one year of related work experience - Strong interpersonal skills with the ability to project warmth and empathy - Effective listening and organizational skills - Strong attention to detail - Experience working across multiple PC systems and applications - Ability to respond efficiently to requests while navigating multiple systems simultaneously and meeting performance metrics and IEX scheduling requirements - Proven customer service skills - Availability to work an 8:30 a.m. – 5:00 p.m. CST shift, Monday through Friday 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 24 - 37 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. At The Cigna Group, 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), 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, click here. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. 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.

Are you passionate about making a difference in people's lives? Do you enjoy working in a service-oriented industry? If so, this opportunity may be the right fit for you! MUST LIVE IN MAINE Required Start date: 4/28/26 SHIFT IS MONDAY- FRIDAY Modivcare is looking for optimistic individuals to join the team as Customer Service Representatives (CSR). You play a part in making a positive impact on members' lives by being a first contact for questions about our service offerings. As a CSR, you will resolve member concerns while ensuring requests are processed in an accurate and timely manner. CSRs are given a structured protocol and scripts to document conversations to ensure consistency of scheduling, modifying, and canceling customer reservations. You will speak with members daily and answer their transportation questions, all while helping support them in their journey towards positive health outcomes. ***WORK FROM HOME REQUIREMENTS*** - High Speed Internet of 25MBPS download and 5MBPS upload. You will be required to provide proof of a speed test. - Ability to directly hardwire to your modem - Required to have a dedicated work area that is separated from other living areas and provides privacy to review company sensitive documents securely. - Attend 100% of training, on camera for the first 30 days of employment. In this role, you will... - Receive and document customer concerns while ensuring all relevant information is correct in a timely manner - Ensure all company procedures are followed - Ensure accurate trip data is input in our systems - Demonstrate a personal commitment to producing high-quality work - Refer unresolved customer grievances to designated department for further investigation and resolution - Multitask effectively and efficiently to extract necessary information from multiple systems - Review and educate members on our services and their insurance coverage. - Support a 24/7/365 contact center environment; schedules may include nights, weekends, and holidays, including company-recognized holidays. Holiday coverage is required. We are excited to speak to someone with the following... - High School Graduate or General Education Degree (GED) - 0-2 years of related experience - 6+ months contact center experience OR customer service experience - Strong organization skills, written, and verbal communication skills. All system documentation will be in English - Can type 35wpm or more - Answer a high volume of calls up to 100+ calls per day - Proficiency in Microsoft Office Suite - Ability to talk and type simultaneously in a clear and concise manner while interacting with customers - Work overtime as required - Ability to work independently under general supervision Sound decision-making and problem-solving skills in a fast-paced environment. Pay Rate- $16/hr Modivcare’s positions are posted and open for applications for a minimum of 5 days. Positions may be posted for a maximum of 45 days dependent on the type of role, the number of roles, and the number of applications received. We encourage our prospective candidates to submit their application(s) expediently so as not to miss out on our opportunities. We frequently post new opportunities and encourage prospective candidates to check back often for new postings. We value our team members and realize the importance of benefits for you and your family. Modivcare offers a comprehensive benefits package to include the following: - Medical, Dental, and Vision insurance - Employer Paid Basic Life Insurance and AD&D - Voluntary Life Insurance (Employee/Spouse/Child) - Health Care and Dependent Care Flexible Spending Accounts - Pre-Tax and Post --Tax Commuter and Parking Benefits - 401(k) Retirement Savings Plan with Company Match - Paid Time Off - Paid Parental Leave - Short-Term and Long-Term Disability - Tuition Reimbursement - Employee Discounts (retail, hotel, food, restaurants, car rental and much more!) Modivcare is an Equal Opportunity Employer. - EEO is The Law - click here for more information - Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled - We consider all applicants for employment without regard to race, color, religion, sex, sexual orientation, national origin, age, handicap or disability, or status as a Vietnam-era or special disabled veteran in accordance with federal law. If you need assistance, please reach out to us at hr.recruiting@modivcare.com