Provider Relations Associate Analyst

Provider Relations Associate Analyst - Evernorth
Pay Rate: $18.37-$27.60/hour (pending, blind rate program)
Schedule

• Training Hours are 8:30am 5:00pm CST
• Regular Hours (after training) are 10:30am 7:00pm CST

Location: Fully remote, but strongly prefer candidates located in CST/PST
Target Start Date: 11/3/2025
Benefits: Health, Dental and Vision

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.

Job Description and Role Summary:
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.

Responsibilities:

• The primary responsibility of this role is to answer inbound claim calls from members or providers, as well as contracting and Provider Relations related calls from providers.
• The work environment is structured, and most of the day will be spent answering these calls from a queue.
• Occasional outbound calls may be necessary for issues requiring follow-up.

Within a call a Claims & PR Advocate may:

• 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 request 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

Skills:

• Customer Service experience
• Able 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

Education:

• A bachelor's degree is required.
• No certs or licenses required.

Attendance Policy

• 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.
  1. 1st unapproved absence or event will result in a Verbal Counseling.
  2. 2nd unapproved absence or event will result in a First Notice.
  3. 3rd unapproved absence or event will result in a Final Notice.
  4. 4th unapproved absence or event will result in termination.

Late Arrivals/Early Departures
Late arrivals and early departures without the appropriate notifications count towards an unscheduled, unapproved absence. Based on business need, a manager may allow a contractor to make-up the time during that business day. However, this does not excuse the behavior.

#TMCS