Eligibility Representative - Remote

What You’ll Do

• Facilitate cross-functional resolution of drug coverage issues & copay coverage & resolve issues impacting referral turn-around time Independently resolve basic patient claims issues using key subject matter knowledge Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates and authorizations Effectively collaborate with internal departments to resolve issues or provide any needed information Contact benefit providers to gather policy benefits/limitations Coordinate and ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.) Perform medical/pharmacy benefit verification requiring complex decision skills based on payer and process knowledge What you’ll need: Must be able to work an 8 hour shift within the hours of 7am - 5pm EST (Mon - Fri) High School diploma or GED required 1+ years of relevant working experience - customer service, billing, healthcare, pharmacy, insurance industry preferred Experience with healthcare, medical insurance terminology and patient access preferred General PC knowledge including experience working with Microsoft Office, Excel, Teams, SharePoint, PowerPoint RX Home, Copay Assistance
• CSP experience a plus Strong data entry skills and computer skills Excellent phone presentation and communication skills Demonstrated ability to handle difficult conversations in a professional manner Ability to adapt in a dynamic work environment and make decisions independently Advanced problem solving skills and the ability to work collaboratively with other departments 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 17.75 - 26 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, paid holidays, and leaves of absence.
• For more details on our employee benefits programs, click here .
• About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives.
• At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve.
• Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients.
• 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.
• Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.
• 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.