Eligibility Representative

🔥 3 minutes ago

🏈 Alabama, South Carolina, +1 more states – Remote

🏈 Alabama – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

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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

• Review and interpret insurance eligibility, coverage details, and benefit limitations to determine clearance requirements. • Initiate outbound communication with insurance plans and third‑party payers to obtain benefit details, resolve coverage questions, and confirm authorization requirements. • Navigate prior authorization processes by gathering required information and ensuring payer criteria are met accurately. • Document benefit findings, authorization outcomes, and clearance decisions thoroughly and consistently within internal systems. • Apply feedback and payer knowledge to continuously improve accuracy, efficiency, and overall clearance quality.

🎯 Requirements

• Minimum of 1 year of experience in a healthcare or health insurance setting performing eligibility verification, benefits investigation, prior authorizations, or patient access support. • Direct experience working with insurance plans or payers, including outbound calls to obtain or clarify coverage information. • Working knowledge of pharmacy (PBM) benefits and medical benefits, with the ability to interpret plan details accurately. • Experience documenting insurance and authorization information with a high level of accuracy and attention to detail. • 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.

🏖️ Benefits

• Health insurance • Retirement plans • Paid time off • Flexible work arrangements