Senior Eligibility Representative

🔥 0 minutes ago

🔔 Pennsylvania – Remote

🔔 Pennsylvania – Remote

⏰ Full Time

🟠 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

• Conduct medical and pharmacy benefit investigations to confirm eligibility, coverage, payer requirements, and patient financial responsibility • Verify insurance eligibility, benefit details, coverage limitations, and documentation requirements for timely referral processing • Identify prior authorization, appeal, step therapy, quantity limit, and other utilization management requirements • Research and resolve complex reimbursement, eligibility, and coverage issues with payers, providers, patients, and internal partners • Educate patients on copay, coinsurance, and financial responsibility • Assist with enrollment in copay assistance, manufacturer support, and patient assistance programs • Document referral activity accurately in company systems and follow departmental procedures • Monitor assigned referrals, manage escalations, and help reduce delays in therapy initiation and treatment continuity

🎯 Requirements

• High school diploma or equivalent • Minimum of 1 year of experience in healthcare, specialty pharmacy, patient access, reimbursement, insurance verification, or a related field • Knowledge of insurance eligibility, coverage requirements, reimbursement processes, prior authorization, or payer requirements • Strong attention to detail and problem-solving skills • Ability to manage multiple priorities while maintaining accuracy • Clear verbal and written communication skills • Ability to explain coverage and financial information professionally • Ability to use computer systems and accurately document work • For home working, cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload

🏖️ Benefits

• Copay assistance, manufacturer support programs, and patient assistance programs, as applicable • Remote work option • Cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload required for home working