Eligibility Representative

🔥 16 hours ago

🌵 Arizona, South Carolina – Remote

🌵 Arizona – Remote 🌴 South Carolina – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 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

• Create and maintain complete patient profiles with demographic, prescription, insurance, prescriber, and clinical information • Review, validate, classify, and route incoming referrals and supporting documents • Evaluate referral and prescription documentation to determine next steps and case routing • Research and resolve missing, incomplete, or conflicting patient, prescriber, insurance, prescription, and clinical information • Communicate and collaborate with patients, prescribers, clients, healthcare providers, insurance representatives, and internal partners • Perform quality checks and complete documentation, system updates, corrective actions, and task handoffs • Follow standard operating procedures, regulatory requirements, and privacy standards • Manage a high volume of referrals while meeting productivity, accuracy, quality, and turnaround-time expectations

🎯 Requirements

• Minimum of 1 year of experience in a healthcare or health insurance setting • Minimum of 1 year of customer service experience • Working knowledge of pharmacy (PBM) benefits and medical benefits, with the ability to interpret plan details accurately • 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 • Must live and work remotely in South Carolina or Arizona • Attention to detail and data accuracy • Knowledge of medical, pharmacy, insurance, and specialty therapy terminology • Ability to interpret referrals, prescriptions, insurance, and clinical documents • Commitment to quality, confidentiality, and compliance • Internet connection through cable broadband or fiber optic service with at least 10Mbps download/5Mbps upload for home working

🏖️ Benefits

• Remote work arrangement • Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload required for home working • Tobacco-free policy • Reasonable accommodation support for the online application process