Eligibility Analyst, Specialty - Evernorth- Remote

The job profile for this position is Eligibility Analyst, which is a Band 2 Senior Contributor Career Track Role.

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Job Description

At CarepathRx, part of Evernorth Health Services, we are ambitious, compassionate experts dedicated to improving access to specialty pharmacy, infusion, and enteral therapies. As an Eligibility Analyst, you will help strengthen our revenue cycle and patient access processes by resolving complex eligibility and authorization issues, identifying trends, and turning insights into better workflows. Your work will support accurate reimbursement, stronger team performance, and a smoother experience for the patients we serve. 

Hours: Monday-Friday, 8:30am-5pm EST

Responsibilities 

• Serve as the primary liaison between Intake and Revenue Cycle Management teams to support timely resolution of escalated insurance verification, eligibility, and authorization concerns. 
• Analyze escalated cases to identify root causes, recurring trends, and process gaps that may affect reimbursement, patient access, or operational quality. 
• Recommend and support process improvements that reduce errors, strengthen accuracy, and improve team efficiency. 
• Partner with supervisors and leaders to implement solutions, monitor results, and share progress toward sustainable improvements. 
• Provide expert guidance on payer requirements, insurance verification, authorization processes, contract pricing, and test claims. 
• Collaborate with intake staff to ensure insurance documentation is complete, accurate, and aligned with reimbursement needs. 
• Maintain reference materials, workflows, and team resources that support consistent and informed decision-making. 
• Coordinate case reviews and cross-functional discussions to align teams on action plans and account resolution. 
• Generate clear reports that summarize issues, resolutions, trends, and recommendations for leadership. 
• Support audits, quality reviews, team education, single patient agreements, price quotes, and other revenue cycle initiatives as needed. 
• Demonstrate reliability, follow-through, clear communication, and pride in delivering high-quality work. 

Qualifications 

Required Qualifications 

• High school diploma or GED. 
• Minimum of 2 years of experience in pharmacy claims, pharmacy technician work, healthcare revenue cycle operations, physician practice operations, ancillary healthcare services, or a related healthcare setting. 
• Knowledge of medical terminology. 
• Proficiency with Microsoft Office applications and other business systems. 
• Strong written and verbal communication skills. 
• Excellent customer service and relationship-building abilities. 
• Strong problem-solving, organization, time management, and follow-through skills. 
• Ability to work independently, manage priorities, and adapt in a fast-paced healthcare environment. 

Preferred Qualifications 

• Experience with insurance verification, eligibility, prior authorization, or pharmacy payer requirements. 
• Knowledge of coordination of benefits, payer websites, reimbursement processes, and authorization guidelines. 
• Experience supporting audits, reporting, quality reviews, process improvement, or team education. 
• Demonstrated ability to collaborate across teams, resolve conflict, and communicate recommendations with confidence and professionalism. 

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 22 - 34 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.

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.

Please note that you must meet our posting guidelines to be eligible for consideration.  Policy can be reviewed at this link.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.