Eligibility Representative- Evernorth- Remote

Eligibility Representative-Evernorth (CarePathRx)

Position Overview

At Evernorth Health Services, we believe access to care starts with clarity, compassion, and trust. As an Insurance Eligibility Representative, you play a critical role in helping patients understand their coverage and financial responsibility so they can focus on their health with confidence. Supporting CarepathRx within our Pharmacy and Care Delivery organization, you will partner with patients, payers, and care teams to ensure accurate insurance verification and a smooth reimbursement experience. This role is ideal for someone who is detail-oriented, patient-focused, and motivated to grow their expertise in specialty pharmacy and infusion services.

Schedule: Monday–Friday, 8:00 AM–6:00 PM EST (rotating shifts)

Key Responsibilities

• Deliver accurate and timely insurance eligibility verification to support patient access to specialty pharmacy and infusion services

• Translate insurance benefits into clear cost estimates and coverage explanations for patients and care teams

• Create and maintain complete, accurate patient profiles, including demographics, insurance details, and authorization status

• Generate financial responsibility letters and review benefits with patients by phone in a supportive, easy-to-understand manner

• Secure prior authorizations and required payer documentation to prevent delays in care

• Coordinate financial assistance applications, payment agreements, and required waivers

• Monitor reimbursement activity, identify issues early, and assist with research to support resolution

• Collaborate with internal partners to ensure a seamless patient and client experience

• Maintain productivity, quality, and accuracy standards while managing multiple priorities

• Demonstrate accountability, follow-through, and pride in delivering reliable, high-quality work

• Contribute to continuous improvement by sharing insights and supporting efficient reimbursement workflows

Qualifications

Required Qualifications

• High school diploma or GED

• Minimum 1 year of experience in insurance verification, prior authorization, or related reimbursement work within a healthcare setting

• Working knowledge of medical terminology

• Proficient computer skills, including Microsoft Office products

• Strong math skills with attention to detail

• Clear written and verbal communication skills

• Strong organization and time management abilities

Preferred Qualifications

• Experience navigating payer websites and eligibility systems

• Understanding of coordination of benefits

• Knowledge of pharmacy versus medical benefit payers

• Familiarity with prior authorization requirements and plan formularies

• Experience supporting specialty pharmacy or infusion services

About CarepathRx at Evernorth

As part of Evernorth Health Services, CarepathRx partners with hospitals and health systems to deliver specialty pharmacy and infusion services that improve outcomes and elevate the patient experience. Our teams are ambitious, compassionate experts committed to learning, growing, and making healthcare simpler and more human every day.

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.

For this position, we anticipate offering an hourly rate of 17.75 - 26 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance.  Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.