Key Facts

Remote From:

Austria , Tennessee (USA) , United States

Full time

Mid-level (2-5 years)

English

Hard Skills

Patient Onboarding Pharmacy Benefit Management Reimbursement Regulations Insurance Reviews Underwriting Customer Complaint Resolution Insurance Reviews Fault Coverage Patient Administration Systems Pharmacy Experience Medical Practice Experience Cross-Functional Collaboration

Other Skills

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Microsoft Office
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Professionalism
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Adaptability
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Interpersonal Communications
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Detail Oriented
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Empathy
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Problem Solving

Roles & Responsibilities

High school diploma or GED required; bachelor’s degree preferred.
2+ years of relevant experience in healthcare or professional office settings with medical insurance knowledge.
Pharmacy/Specialty pharmacy experience is a plus.
Proficient in Microsoft Office (Word, Outlook, Excel) with strong written and verbal communication; ability to adapt in a dynamic environment and work with minimal supervision.

Requirements:

Performs medical/pharmacy benefit verification by contacting insurance companies or using provider portals for drug coverage and benefits.
Facilitates cross-functional resolution of drug coverage issues to ensure timely onboarding of specialty patients.
Performs insurance review on the day of shipment to ensure reimbursement criteria are met and reduce the risk of bad debt.
Collaborates with internal departments to resolve issues using professional communication and escalates to leadership as appropriate.

Job description

As an Eligibility Representative, you’ll be part of a dedicated team which helps our specialty pharmacy patients coordinate their medication needs and pharmacy insurance coverage for complex medical conditions.  This role handles each inquiry with care, detail, and most importantly, empathy. 

Here’s a little more on how you’ll make a difference:

PRIMARY RESPONSIBILITIES:

Performs medical/pharmacy benefit verification by contacting insurance company or using provider portals for drug coverage and benefits.
Facilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues resulting in timely onboarding of specialty patients
Coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).
Perform insurance review on day of shipment to ensure insurance criteria is met for reimbursement and reduce the risk of bad debt
Effectively collaborates with internal departments to resolve issues or provide any needed information using professional communication at all times.
Use discretion & independent judgement in handling patient or more complex client complaints, escalating to leadership as appropriate.
Completes other projects and additional duties as assigned.

QUALIFICATIONS:

High school diploma or GED required, bachelor’s degree preferred.
2+ years of relevant working experience.
Health care or professional office experience with medical insurance knowledge and terminology and experience in patient access preferred.
Pharmacy/Specialty pharmacy experience a plus
Proficient in Microsoft Office Products- Word, Outlook, Excel
Excellent communication skills, including written, and oral phone presentation.
Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
Problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions.

Training Schedule : Mon-Fri 8:00am-5:00pm CST for 12 weeks

Work Schedule (Post Training): Mon-Fri 10:00am- 7:00pm CST

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.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. 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.