The Eligibility Senior Representative plays an important role in helping patients navigate access to the medications they need. This position performs specialized patient access functions requiring an advanced understanding of insurance benefits and processes to successfully communicate with Payers, Pharma, Physicians, and Patients. Using experience and knowledge of industry best practices, this individual communicates updates on pending referrals that may have an adverse impact on the patient experience. This role proactively recognizes trends, identifies and clarifies patients’ needs, and works toward solutions that help create a smoother patient experience.

What you’ll do to make a difference:

• Facilitate cross-functional resolution of drug coverage issues and proactively address, research, and resolve issues impacting referral turnaround time.
• Independently resolve basic patient claims issues using key subject matter knowledge.
• Prepare and review claims to ensure accuracy and alignment with payer requirements, including but not limited to codes, dates, and authorizations.
• Effectively collaborate with internal departments to resolve issues or provide needed information, always using professional communication.
• Contact benefit providers to gather policy benefits and limitations.
• Perform medical/pharmacy benefits verification requiring complex decision-making skills based on payer and process knowledge.
• Complete other projects and additional duties as assigned.

What you’ll need to be successful:

• High school diploma or GED required.
• At least 2+ years of related working experience.
• Must have healthcare experience with medical insurance knowledge and terminology, along with experience in patient access.
• Intermediate data entry skills and working knowledge of Microsoft Office.
• Excellent phone presentation and communication skills.
• Demonstrated ability to professionally handle challenging customer situations.
• Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
• Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions.
  

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 19 - 29 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 Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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 [email protected] 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.