Eligibility Analyst, Specialty

🔥 10 minutes ago

🇺🇸 United States – Remote

💵 $22 - $34 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🧐 Analyst

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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The Cigna Group

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1982

🏥 Healthcare

⚕️ Healthcare Insurance

💊 Pharmaceuticals

Healthcare • Healthcare Insurance • Pharmaceuticals

The Cigna Group is a global health company committed to improving the health and vitality of its clients, customers, and patients. With its two divisions, Cigna Healthcare and Evernorth Health Services, the company focuses on enhancing quality of life through healthcare services and pharmacy benefits management. The Cigna Group is dedicated to ethical practices in healthcare and artificial intelligence, and strives to create positive change in the healthcare system. It also emphasizes its Environmental, Social, and Governance (ESG) responsibilities, aiming to impact health equity and foster innovation in healthcare delivery.

📋 Description

• Serve as the primary liaison between Intake and Revenue Cycle Management teams to resolve escalated insurance verification, eligibility, and authorization concerns • Analyze escalated cases to identify root causes, recurring trends, and process gaps affecting reimbursement, patient access, or operational quality • Recommend and support process improvements that reduce errors, strengthen accuracy, and improve team efficiency • Partner with supervisors and leaders to implement solutions, monitor results, and share progress toward sustainable improvements • Provide expert guidance on payer requirements, insurance verification, authorization processes, contract pricing, and test claims • Collaborate with intake staff to ensure insurance documentation is complete, accurate, and aligned with reimbursement needs • Maintain reference materials, workflows, and team resources supporting consistent decision-making • Coordinate case reviews and cross-functional discussions to align teams on action plans and account resolution • Generate reports summarizing issues, resolutions, trends, and recommendations for leadership • Support audits, quality reviews, team education, single patient agreements, price quotes, and other revenue cycle initiatives as needed

🎯 Requirements

• High school diploma or GED • Minimum of 2 years of experience in pharmacy claims, pharmacy technician work, healthcare revenue cycle operations, physician practice operations, ancillary healthcare services, or a related healthcare setting • Knowledge of medical terminology • Proficiency with Microsoft Office applications and other business systems • Strong written and verbal communication skills • Excellent customer service and relationship-building abilities • Strong problem-solving, organization, time management, and follow-through skills • Ability to work independently, manage priorities, and adapt in a fast-paced healthcare environment • Experience with insurance verification, eligibility, prior authorization, or pharmacy payer requirements preferred • Knowledge of coordination of benefits, payer websites, reimbursement processes, and authorization guidelines preferred • Experience supporting audits, reporting, quality reviews, process improvement, or team education preferred • Internet connection through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload if working at home • Must work Monday-Friday, 8:30am-5pm EST

🏖️ Benefits

• Annual bonus plan eligibility • Medical insurance • Vision insurance • Dental insurance • 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 • Remote work arrangement