Job Description
Eligibility Representative - Remote As an Eligibility Representative, you will be part of a team passionate about helping our patients with
billing and ensuring their access to life saving medications.
Responsibilities - Answer inbound calls from patients and providers about claims, account issues, and scheduling
medication shipments
- An average of 25-35 OB calls are expected daily
- Facilitate cross-functional resolution of drug coverage issues and proactively address, research,
and resolve issues impacting referral turn-around time
- Independently resolve basic patient claims issues using key subject matter knowledge
- Effectively collaborate with internal departments to resolve issues or provide any needed
information
- Contact benefit providers to gather policy benefits/limitations
- Coordinate and ensure services provided will be reimbursable (e.g., deductible amounts, copayments, effective date, levels of care, authorization, etc.)
- Perform medical/pharmacy benefit verification requiring complex decision skills based on payer
and process knowledge.
Qualifications - Experience with healthcare, medical insurance terminology, and patient access preferred
- Excellent phone presentation and communication skills
- Demonstrated ability to handle difficult conversations in a professional manner.
- Strong data entry skills and computer skills.
Requirements - High school diploma or equivalent
- Must have reliable internet connectivity through a wired internet connection (hot spots or mobile
internet are not allowed)
- Must have a private dedicated workspace that is free of distractions
- Availability to attend 100% of training within the first 90 days of employment.
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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response. 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.
eQuest
Job Tags
Remote job, Full time,