Senior Eligibility Representative

Job not on LinkedIn

🔥 14 hours ago

🇺🇸 United States – Remote

💵 $19 - $29 / hour

⏰ Full Time

🟠 Senior

👻 Ghost score 0%

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

• 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. • 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 copay assistance, manufacturer support, and patient assistance programs, as applicable. • Document referral activity accurately in company systems and follow departmental procedures. • 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, problem-solving skills, and ability to manage multiple priorities while maintaining accuracy. • Clear verbal and written communication skills with the ability to explain coverage and financial information in a professional way. • Ability to use computer systems and accurately document work. • If working at home occasionally or permanently, cable broadband or fiber optic internet service with at least 10Mbps download/5Mbps upload.

🏖️ 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