Eligibility Representative - Remote

As an Eligibility Representative, you will be part of a team passionate about helping our patients with billing and ensuring their access to life saving medications.  

What you’ll do:

• Deliver straightforward administrative and/or other basic business services in Eligibility

• Implement and maintain eligibility for benefits

• Implement, update, and maintain automated, direct connect and/or manual eligibility data

• Interact with internal partners and/or external clients/vendors

• Generate reports to identify and resolve discrepancies

• Identify process improvement opportunities for own cases

• Negotiate and resolve eligibility with clients

• Facilitate cross-functional resolution of drug coverage issues & proactively address, research & 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

• Provide technical support for the electronic processing of eligibility

• Ensure customer data is installed accurately and timely

• Work with client's format and internal systems to resolve errors

• Interact with systems to resolve technical issues

What you’ll need:

• Must be able to work an 8 hour shift within the hours of 7am - 6pm 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 knowledge & understanding of manual and automated eligibility

• General PC knowledge including experience working with Microsoft Office, Excel, Teams, SharePoint, PowerPoint

• Familiar with reporting tools and/or RX Home, Copay Assistance, or 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

• Works to clearly defined procedures under close supervision

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.