Eligibility Representative

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $17 - $26 / hour

⏰ Full Time

🟢 Junior

🚫👨‍🎓 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

• Deliver straightforward administrative and basic business services in Eligibility • Implement, update, and maintain eligibility benefits and eligibility data • Interact with internal partners and external clients/vendors • Generate reports to identify and resolve discrepancies • Identify process improvement opportunities • Negotiate and resolve eligibility issues with clients • Facilitate cross-functional resolution of drug coverage issues • Research and resolve issues affecting referral turnaround time • Resolve basic patient claims issues • Prepare and review claims for accuracy against payer requirements, including codes, dates, and authorizations • Collaborate with internal departments to resolve issues and provide information • Contact benefit providers to gather policy benefits and limitations • Coordinate reimbursable services, including deductibles, copayments, effective dates, levels of care, and authorizations • Perform complex medical/pharmacy benefit verification • Provide technical support for electronic eligibility processing • Ensure customer data is installed accurately and timely • Use client formats and internal systems to resolve errors • Interact with systems to resolve technical issues

🎯 Requirements

• Must be able to work an 8-hour shift within 7am–6pm EST, Monday–Friday • High School diploma or GED required • 1+ years of relevant working experience; customer service, billing, healthcare, pharmacy, or insurance industry experience preferred • Experience with healthcare, medical insurance terminology, and patient access preferred • General knowledge and understanding of manual and automated eligibility • General PC knowledge, including Microsoft Office, Excel, Teams, SharePoint, and PowerPoint • Familiarity with reporting tools and/or RX Home, Copay Assistance, or CSP experience is a plus • Strong data entry and computer skills • Excellent phone presentation and communication skills • Demonstrated ability to handle difficult conversations professionally • Ability to adapt in a dynamic work environment and make decisions independently • Advanced problem-solving skills and ability to work collaboratively with other departments • Ability to work to clearly defined procedures under close supervision • For home-based work, cable broadband or fiber optic internet with at least 10 Mbps download and 5 Mbps upload required

🏖️ 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 • Tobacco-free policy