Eligibility Representative, Specialty - Evernorth- Remote

The job profile for this position is Eligibility Representative, which is a Band 1 Professional Career Track Role.

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Insurance Verification Coordinator, Specialty (Eligibility Representative) – Evernorth – Remote

Position Summary

As an Insurance Verification Coordinator, you will help patients access the care they need by ensuring accurate insurance verification, clear communication of benefits, and timely completion of reimbursement requirements. You will play a key role in creating a smooth, supportive experience for patients and providers.

Hours/Schedule: Monday-Friday, 8:30am-5:00pm EST

Responsibilities

• Verify patient insurance coverage, calculate estimated costs, and document details clearly in the patient profile.

• Enter and update accurate patient demographics in the system.

• Generate coverage and financial responsibility quotes and review benefits with patients by phone.

• Track, monitor, and secure required insurance and reimbursement documents.

• Obtain prior authorizations and coordinate financial assistance forms, payment agreements, and waivers.

• Support onboarding by helping train new employees.

• Organize and prioritize daily tasks to meet productivity and quality standards.

• Create new hospital and physician codes as needed.

• Partner with internal teams to ensure smooth reimbursement workflows and excellent client service.

• Research reimbursement issues and contribute to continuous improvement efforts.

Required Qualifications

• High school diploma or GED.

• 1+ year of insurance verification, prior authorization, or related experience in a healthcare setting.

• Knowledge of medical terminology.

• Proficient computer skills, including Microsoft Office.

• Strong math, communication, and organizational skills.

Preferred Qualifications

• Experience with payer websites and coordination of benefits.

• Knowledge of pharmacy vs. medical payers and authorization processes.

• Familiarity with plan formularies and authorization requirements.

As part of Evernorth Health Services, this role supports CarepathRx within our Pharmacy and Care Delivery organization. Our team focuses on specialty pharmacy and infusion services in partnership with hospitals and health systems.

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 - 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.

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.