Senior Eligibility Representative

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🔥 5 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – 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

• Facilitate cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time. • Independently resolve basic patient claims issues using key subject matter knowledge. • Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates, and authorizations. • Effectively collaborate with internal departments to resolve issues or provide any needed information, always using professional communication. • Contact benefit providers to gather policy benefits/limitations. • Perform medical /pharmacy benefits verification requiring complex decision skills based on payer and process knowledge. • Complete other projects and additional duties as assigned.

🎯 Requirements

• High school diploma or GED required, bachelor’s degree preferred • At least 2+ years of related working experience. • Must have Health care experience with medical insurance knowledge and terminology and experience in patient access. • Intermediate data entry skills and working knowledge of Microsoft Office. • Excellent phone presentation and communication skills. • Demonstrated ability to handle professionally challenging customers. • Ability to adapt in a dynamic work environment and make decisions with minimal supervision. • Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions. • Prior Authorization experience

🏖️ Benefits

• If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.