As a Clinical Nurse Advisor, you will be responsible for contacting insured members to explain denials of coverage and provide clear, compassionate, and professional support. You will work closely with our clinical and customer service teams to ensure members understand the rationale behind decisions, while offering guidance on next steps, alternative options, or appeals when applicable.

Main Responsibilities

• Member Outreach: Proactively contact members whose claims or coverage have been denied to explain decisions with clarity and empathy.

• Clinical Communication: Translate complex medical and insurance terminology into easy-to-understand language for members.

• Support & Guidance: Assist members in exploring potential next steps, alternative care options, or appeal processes as needed.

• Collaborative Problem-Solving: Work with internal teams (clinical, operations, customer service) to address member concerns and ensure seamless communication.

• Documentation: Maintain accurate and detailed records of member interactions in compliance with company policies and data privacy regulations.

Skills and Qualifications

• Education & Licensing: Registered Nurse (RN) with a current valid license.

• Minimum of 3 years of clinical experience (experience in case management or health insurance preferred).

• Communication Expertise: Strong verbal and written communication skills with the ability to convey complex medical and insurance information in an empathetic and professional manner.

• Proficiency in English at a C1 level or higher. Any other global language will be consider as plus.

• Interpersonal Skills: Exceptional listening and problem-solving abilities, empathy and patience when addressing member concerns.

• Tech-Savvy: Comfortable working in a digital environment with proficiency in Microsoft Office and CRM tools.

• Ability to adapt to new technologies and systems quickly.

• Organized & Detail-Oriented:

• Skilled in multitasking, prioritizing responsibilities, and maintaining accurate documentation.

• Flexibility:

• Able to work in a hybrid environment (remote and in-office).

About Cigna Healthcare

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.