Eligibility Representative

🔥 0 minutes ago

🌵 Arizona, Tennessee, +1 more states – Remote

🌵 Arizona – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

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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

• Verify insurance benefits and navigate coverage requirements to help patients access medications • Provide support to patients, providers, and internal partners throughout the patient journey • Handle approximately 10–15 inbound calls daily regarding claims, account inquiries, insurance coverage, and medication shipment coordination • Complete an average of 25–35 outbound calls daily to insurance carriers, providers, patients, and internal partners • Research and resolve patient claims and coverage issues using established processes and subject matter expertise • Verify eligibility, benefits, coverage limitations, deductibles, copays, authorizations, and levels of care with insurance providers • Perform medical and pharmacy benefit investigations using payer-specific requirements and guidelines • Coordinate with cross-functional teams to resolve issues affecting referral turnaround times • Collaborate with internal departments to support patient access to therapy • Ensure services are reimbursable and accurately documented according to payer requirements

🎯 Requirements

• RxHome experience preferred • Previous experience in healthcare, medical insurance, patient access, eligibility verification, benefits investigation, or a related field preferred • Strong understanding of healthcare and medical insurance terminology • Excellent verbal and written communication skills with a professional phone presence • Ability to manage difficult conversations with professionalism, empathy, and confidence • Strong attention to detail and organizational skills • Ability to multitask in a fast-paced environment • Proficiency with computer applications and data entry • High school diploma or equivalent required • Reliable high-speed internet through a wired connection; hotspots and mobile internet are not permitted • Private, distraction-free workspace while working remotely • Open availability Monday through Friday between 7:00 AM and 7:00 PM CST • Ability to attend and successfully complete all required training during the first 90 days of employment • Cable broadband or fiber optic internet service with at least 10 Mbps download and 5 Mbps upload

🏖️ Benefits

• Remote work arrangement • Approximately 8–12 weeks of classroom and on-the-job training • Full-time employment