Eligibility Representative

🔥 8 minutes ago

🌵 Arizona, South Carolina – Remote

🌵 Arizona – Remote 🌴 South Carolina – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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

• Create and maintain complete patient profiles by accurately entering and updating demographic, prescription, insurance, prescriber, and relevant clinical information in internal systems • Review, validate, classify, and route incoming referrals and supporting documents according to established intake workflows and case requirements • Evaluate referral and prescription documentation using knowledge of specialty medications, therapies, and treatment categories to determine next steps and appropriate case routing • Research and resolve missing, incomplete, or conflicting patient, prescriber, insurance, prescription, and clinical information to prevent processing delays • Communicate and collaborate with patients, prescribers, clients, healthcare providers, insurance representatives, and internal partners to complete referrals, remove barriers, and support timely access to therapy • Perform quality checks and complete required documentation, system updates, corrective actions, and task handoffs while following Standard Operating Procedures, regulatory requirements, and privacy standards • Manage a high volume of referrals while meeting productivity, accuracy, quality, and turnaround-time expectations

🎯 Requirements

• Minimum of 1 year of experience in a healthcare or health insurance setting • Minimum of 1 year of customer service experience • Working knowledge of pharmacy (PBM) benefits and medical benefits, with the ability to interpret plan details accurately • Ability to manage detailed, repetitive work in a structured environment while maintaining consistency and quality • Strong written and verbal communication skills appropriate for professional interactions with payer representatives • High School Diploma or equivalent • Must live and work remotely in South Carolina or Arizona • Internet connection obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload when working at home • Attention to detail and data accuracy • Knowledge of medical, pharmacy, insurance, and specialty therapy terminology • Ability to interpret referrals, prescriptions, insurance, and clinical documents • Organization, research, and problem-solving skills • Ability to prioritize work and meet performance expectations • Commitment to quality, confidentiality, and compliance

🏖️ Benefits

• Remote work arrangement • Cable broadband or fiber optic internet service requirement with speeds of at least 10Mbps download/5Mbps upload for home working • Tobacco-free policy; qualifying smoking cessation program available where applicable