Eligibility Representative

🔥 0 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Verify insurance benefits and navigate coverage requirements to help patients access medications • Provide support to patients, providers, and internal partners throughout the patient journey • Handle approximately 10–15 inbound calls daily regarding claims, account inquiries, insurance coverage, and medication shipment coordination • Complete an average of 25–35 outbound calls daily to insurance carriers, providers, patients, and internal partners • Research and resolve patient claims and coverage issues using established processes and subject matter expertise • Verify eligibility, benefits, coverage limitations, deductibles, copays, authorizations, and levels of care with insurance providers • Perform detailed medical and pharmacy benefit investigations using payer-specific requirements and guidelines • Coordinate with cross-functional teams to address issues affecting referral turnaround times • Collaborate with internal departments to gather and provide information supporting patient access to therapy • Ensure services are reimbursable and accurately documented according to payer requirements

🎯 Requirements

• Previous experience in healthcare, medical insurance, patient access, eligibility verification, benefits investigation, or a related field • RxHome experience preferred • Strong understanding of healthcare and medical insurance terminology • Excellent verbal and written communication skills with a professional phone presence • Ability to manage difficult conversations with professionalism, empathy, and confidence • Strong attention to detail and organizational skills • Ability to multitask in a fast-paced environment • Proficiency with computer applications and data entry • High school diploma or equivalent required • Reliable high-speed internet through a wired connection; hotspots and mobile internet are not permitted • Private, distraction-free workspace while working remotely • Ability to attend and successfully complete all required training during the first 90 days of employment • Cable broadband or fiber optic internet service with at least 10Mbps download and 5Mbps upload speeds

🏖️ Benefits

• Remote work arrangement • Approximately 8–12 weeks of classroom and on-the-job training • Training schedule Monday through Friday, 8:00 AM–5:00 PM CST • Required training completion during the first 90 days of employment • Reliable high-speed wired internet for remote work • Private, distraction-free workspace • Tobacco-free policy • Reasonable accommodation assistance for the online application process