Eligibility Representative

🔥 0 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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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 • Handle approximately 10–15 inbound calls daily from patients and providers regarding claims, accounts, insurance coverage, and medication shipments • Complete approximately 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 medical and pharmacy benefit investigations according to payer-specific requirements and guidelines • Coordinate with cross-functional teams to resolve issues affecting referral turnaround times • Gather and provide information to support patient access to therapy • Ensure services are reimbursable and accurately documented according to payer requirements

🎯 Requirements

• RxHome experience preferred • Previous experience in healthcare, medical insurance, patient access, eligibility verification, benefits investigation, or a related field • 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 10 Mbps download and 5 Mbps upload