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: 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. For this position, we anticipate offering an hourly rate of 17 - 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, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here. 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.