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

• Handle approximately 10–15 inbound calls daily from patients and providers 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 • Contact insurance providers to verify eligibility, benefits, coverage limitations, deductibles, copays, authorizations, and levels of care • Perform detailed medical and pharmacy benefit investigations while applying payer-specific requirements and guidelines • Coordinate with cross-functional teams to proactively address issues impacting referral turnaround times • Collaborate with internal departments to gather and provide information supporting patient access to therapy • Ensure services provided are reimbursable and accurately documented in accordance with 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 • 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 if working from home

🏖️ Benefits

• Remote work arrangement • Approximately 8–12 weeks of classroom and on-the-job training • Training schedule Monday through Friday, 8:00 AM–5:00 PM CST • Tobacco/nicotine cessation program eligibility where applicable • Reasonable accommodation support for the online application process