Eligibility Representative

The job profile for this position is Eligibility Representative, which is a Band 1 Professional Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. 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: Review and interpret insurance eligibility, coverage details, and benefit limitations to determine clearance requirements. Initiate outbound communication with insurance plans and third‑party payers to obtain benefit details, resolve coverage questions, and confirm authorization requirements. Navigate prior authorization processes by gathering required information and ensuring payer criteria are met accurately. Document benefit findings, authorization outcomes, and clearance decisions thoroughly and consistently within internal systems. Apply feedback and payer knowledge to continuously improve accuracy, efficiency, and overall clearance quality. QUALIFICATIONS: Minimum of 1 year of experience in a healthcare or health insurance setting performing eligibility verification, benefits investigation, prior authorizations, or patient access support. Direct experience working with insurance plans or payers, including outbound calls to obtain or clarify coverage information. Working knowledge of pharmacy (PBM) benefits and medical benefits, with the ability to interpret plan details accurately. Experience documenting insurance and authorization information with a high level of accuracy and attention to detail. Ability to manage detailed, repetitive work in a structured environment while maintaining consistency and quality. Strong written and verbal communication skills appropriate for professional interactions with payer representatives. High School Diploma or equivalent. Must live and work remotely in one the following states: Alabama, Indiana, South Carolina, or Tennessee. 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. 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. Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.