Senior Eligibility Representative

🔥 0 minutes ago

🌵 Arizona, Pennsylvania, +1 more states – Remote

🌵 Arizona – Remote 🔔 Pennsylvania – Remote 🤠 Texas – Remote

⏰ Full Time

🟠 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

• Conduct medical and pharmacy benefit investigations to confirm eligibility, coverage, payer requirements, and patient financial responsibility • Verify insurance eligibility, benefit details, coverage limitations, and documentation requirements for timely referral processing • Identify prior authorization, appeal, step therapy, quantity limit, and other utilization management requirements affecting therapy access • Research and resolve complex reimbursement, eligibility, and coverage issues with payers, providers, patients, and internal partners • Educate patients on copay, coinsurance, and financial responsibility • Assist with enrollment in available copay assistance, manufacturer support, and patient assistance programs • Document referral activity accurately in company systems and follow departmental procedures for service, quality, and compliance • Monitor assigned referrals, manage escalations, and help reduce delays in therapy initiation and treatment continuity

🎯 Requirements

• High school diploma or equivalent • Minimum of 1 year of experience in healthcare, specialty pharmacy, patient access, reimbursement, insurance verification, or a related field • Knowledge of insurance eligibility, coverage requirements, reimbursement processes, prior authorization, or payer requirements • Strong attention to detail and problem-solving skills • Ability to manage multiple priorities while maintaining accuracy • Clear verbal and written communication skills • Ability to explain coverage and financial information professionally • Ability to use computer systems and accurately document work • Experience conducting medical and pharmacy benefit investigations preferred • Experience supporting specialty pharmacy, patient access, reimbursement, or new referral intake workflows preferred • Experience with complex medical and pharmacy benefit structures or payer requirements preferred • Knowledge of specialty drug reimbursement, copay assistance, manufacturer support programs, or patient assistance programs preferred • For home work, cable broadband or fiber optic internet with at least 10Mbps download/5Mbps upload

🏖️ Benefits

• Copay assistance, manufacturer support programs, and patient assistance programs, as applicable • Remote work arrangement • Tobacco-free policy • Reasonable accommodation support for the online application process