Senior Eligibility Representative

🔥 0 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $19 - $29 / hour

⏰ 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

• Review patient accounts, insurance requirements, authorization status, and coverage details to determine shipment readiness. • Identify and resolve barriers preventing medication shipment, including claim rejections, reimbursement issues, benefit concerns, and payer requirements. • Coordinate benefit review, claim resolution, authorization validation, and payer requirement review to clear patients for shipment. • Research coverage and reimbursement challenges and determine next steps, escalation needs, and resolution plans. • Partner with pharmacy operations, patient access teams, healthcare providers, payers, manufacturers, and internal stakeholders to support timely shipment outcomes. • Escalate high-risk shipment barriers that could cause therapy interruption, delayed treatment, patient dissatisfaction, or financial impact. • Communicate shipment status, issue resolution, and trends to business partners and external contacts. • Serve as a subject matter resource for complex shipment clearance questions, insurance requirements, and patient access barriers. • Support process improvements, training, best-practice sharing, and special projects that improve shipment clearance and patient access outcomes.

🎯 Requirements

• Must be able to work Monday–Friday, 11:00 AM–8:00 PM EST • High school diploma or GED • Minimum of 3 years of experience in healthcare, specialty pharmacy, patient access, insurance verification, reimbursement, revenue cycle management, or a related field • Knowledge of medical or pharmacy insurance benefits, authorization requirements, payer requirements, claims, and reimbursement processes • Strong problem-solving and analytical skills • Excellent verbal and written communication skills • Ability to manage multiple priorities in a fast-paced environment while maintaining accuracy, follow-through, and attention to detail • Ability to work independently, use sound judgment, and collaborate across teams • If working at home, internet service must be through cable broadband or fiber optic with at least 10 Mbps download/5 Mbps upload • Preferred: associate or bachelor's degree • Preferred experience in specialty pharmacy, advanced therapy, patient access, or shipment clearance operations • Preferred experience resolving claim rejections, coverage issues, reimbursement barriers, or payer-related shipment delays • Preferred experience working with healthcare providers, payer organizations, manufacturer contacts, pharmacy operations, or cross-functional business partners • Preferred knowledge of Express Scripts, Evernorth, or related pharmacy systems, products, and services • Preferred experience supporting process improvement, training, workflow enhancements, or operational projects

🏖️ Benefits

• Annual bonus plan eligibility • Medical benefits • Vision benefits • Dental benefits • Well-being and behavioral health programs • 401(k) • Company-paid life insurance • Tuition reimbursement • Minimum of 18 days of paid time off per year • Paid holidays • Leaves of absence