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Supervisor DME Case Administrator - Work at Home - eviCore at Cigna in Bloomfield, Connecticut

Posted in General Business 18 days ago.

Type: Full-Time

Job Description:

Leads Case Management team consisting of experienced administrative and operative roles in the Professional career track. Oversees and coordinates the activities DME case managers. Provides direction, guides, and supports staff in the day-to-day operations including working with DME providers, members, and their families. Ensures the resolution of disputes of members, their families, and vendors. Typically responsible for a large number of direct and indirect reports in a process or transactional operations environment. Coordinates schedules and workflow for the team. Focuses on team completion of assignments and routines. Ensures the orientation and training of employees. This role typically leads a team focusing on case processing and customer service. Position typically requires excellent interpersonal skills, ability to understand and interpret policy provisions. Independently responds to inquiries, grievances, complaints or appeals ranging from routine to moderate complexity. Good knowledge and understanding of Customer Service and business/operating processes and procedures.

What you must have

  • High School graduate with diploma or GED.

  • Associates or Bachelor's degree preferred.

  • 5+ year of experience in healthcare contact center or customer service preferred.

  • Medical background with DME experience preferred.

  • Experience with insurance products including Managed Care, Medicare Advantage, Medicare and Medicaid preferred.

  • Various schedules to cover operating hours (7AM - 8PM CST). Maintain flexibility to variations in work volume/work schedule, which sometimes require extended working hours.

  • Position may require rotating weekend and holiday coverage. Certain postings may require regular weekend coverage based on business and client needs.

  • Currently position is remote but position location is subject to change.

  • Provides excellent customer service to clients and providers by ensuring there is full understanding of the resolution or action plan.

  • Ability to navigate multiple platforms that contain provider data, member information, and authorizations.

  • Daily focus on managing agents productivity standards, recommending new approaches for enhancing performance and productivity when appropriate.

  • Time-management: Ability to effectively manage one's time and resources to ensure that work is completed efficiently. Excellent organizational skills.

  • Communication: Ability to provide clear verbal and written information via in-person, email, and phone to customers, co-workers, direct reports and leadership.

  • Critical-Thinking/Decision-making: Ability to choose a course of action or developing appropriate solutions by identifying and understanding issues, problems, and opportunities.

  • Autonomy: Ability to work independently with little to no supervision.

  • Ability to complete special projects or other duties as assigned.

  • Proficient with various applications or software, such as: Microsoft Outlook, Word, Excel, and PowerPoint and demonstrate ability to utilize all resources to support the manual functionality of the PAC system.

Duties and Responsibilities

  • Manage day to day operations for both direct and indirect reports

  • Manage communications for internal communications

  • Coaching

  • Maintain workflow activities for the DME Health plan product for inbound and outbound communications between eviCore Healthcare stakeholders, members, physicians and DME vendors.

  • Demonstrate complete understanding of how to research and resolve issues pertaining to the pre-certification process and day-to-day operational concerns using defined processes.

  • Demonstrate full understanding and ability to differentiate the DME processes over multiple health plans across multiple states to ensure compliance with both Medicare, Medicaid and Commercial guidelines by state regulations.

  • Communicate all state specific and national health care laws to members, physicians and DME providers including the appeals/reconsideration policies.

  • Possible Inbound and outbound communications tasks include coordination of inbound requests from vendors, physicians and members for authorization, status checks on existing cases, and directing calls to internal departments, notification calls to members and DME providers regarding incomplete authorization requests, as well as authorization approvals.

  • Evaluate client trends to report and partner with the appropriate internal stakeholders in order to address and resolve through facilitation of communication between clients, providers, IT and other eviCore healthcare team members.

  • Position is part of a call center.

  • Required to complete pre-employment skill test for typing and computer literacy.

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 annual salary of 60,100 - 100,100 USD / yearly, 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 Life at Cigna .

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you'll enjoy meaningful career experiences that enrich people's lives. What difference will you make?

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: for support. Do not email for an update on your application or to provide your resume as you will not receive a response.

Cigna 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.

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