Eligibility Representative

🔥 8 minutes ago

🏈 Alabama, South Carolina, +1 more states – Remote

🏈 Alabama – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote

⏰ Full Time

🟢 Junior

✨ Representative

🚫👨‍🎓 No degree required

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛡️ Insurance

Healthcare • Insurance

The Cigna Group is a global health services company that provides medical, dental, pharmacy, behavioral and supplemental insurance products and benefits to individuals, families, employers, brokers, providers and Medicare beneficiaries. It offers employer-sponsored group plans, individual and family plans (including Open Enrollment offerings), Medicare, international health insurance covering more than 200 countries, and digital member services through the myCigna platform (including telehealth and claims management). Its products are delivered through operating subsidiaries such as Cigna Health and Life Insurance Company and other regional affiliates.

📋 Description

• Review and interpret insurance eligibility, coverage details, and benefit limitations to determine clearance requirements. • Initiate outbound communication with insurance plans and third‑party payers to obtain benefit details, resolve coverage questions, and confirm authorization requirements. • Navigate prior authorization processes by gathering required information and ensuring payer criteria are met accurately. • Document benefit findings, authorization outcomes, and clearance decisions thoroughly and consistently within internal systems. • Apply feedback and payer knowledge to continuously improve accuracy, efficiency, and overall clearance quality.

🎯 Requirements

• Minimum of 1 year of experience in a healthcare or health insurance setting performing eligibility verification, benefits investigation, prior authorizations, or patient access support. • Direct experience working with insurance plans or payers, including outbound calls to obtain or clarify coverage information. • Working knowledge of pharmacy (PBM) benefits and medical benefits, with the ability to interpret plan details accurately. • Experience documenting insurance and authorization information with a high level of accuracy and attention to detail. • Ability to manage detailed, repetitive work in a structured environment while maintaining consistency and quality. • Strong written and verbal communication skills appropriate for professional interactions with payer representatives. • High School Diploma or equivalent.

🏖️ Benefits

• Must live and work remotely in one of the following states: Alabama, Indiana, South Carolina, or Tennessee. • Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.