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.
+ 2-3 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.
For this position, we anticipate offering an hourly rate of 17.75 - 25 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.
We want you to be healthy, balanced, and feel secure. That's why 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) with company match, 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, visit Life at Cigna Group .
**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:_
[email protected]_ _for support. Do not email_
[email protected]_ _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._
_Qualified applicants with criminal histories will be considered for employment in a manner_ _consistent with all federal, state and local ordinances._
Job Tags
Hourly pay, Work experience placement, Work at office, Local area, Remote work, Work from home,