[Hiring] Eligibility Senior Representative @The Cigna Group

Role Description

The Eligibility Senior Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes to successfully liaise with Payers, Pharma, Physicians, and Patients. This individual can proactively recognize cause and effect trends, identify and clarify patients’ needs, and work towards solutions.

Hours/Schedule: Monday- Friday, 9am-5:30pm EST

What you'll do to make a difference:

• Facilitate cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time.
• Independently resolve basic patient claims issues using key subject matter knowledge.
• Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates, and authorizations.
• Effectively collaborate with internal departments to resolve issues or provide any needed information, always using professional communication.
• Contact benefit providers to gather policy benefits/limitations.
• Perform medical/pharmacy benefits verification requiring complex decision skills based on payer and process knowledge.
• Complete other projects and additional duties as assigned.

Qualifications

• High school diploma or GED required.
• RxHome experience preferred.
• At least 2+ years of related working experience.
• Must have healthcare experience with medical insurance knowledge and terminology and experience in patient access.
• Intermediate data entry skills and working knowledge of Microsoft Office.
• Excellent phone presentation and communication skills.
• Demonstrated ability to handle professionally challenging customers.
• Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
• Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions.

Requirements

• If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Benefits

• Hourly rate of 19 - 29 USD / hourly, depending on relevant factors, including experience and geographic location.
• Eligible to participate in an annual bonus plan.
• Comprehensive range of benefits, including medical, vision, dental, and well-being and behavioral health programs.
• 401(k) and company paid life insurance.
• Tuition reimbursement.
• A minimum of 18 days of paid time off per year and paid holidays.