Eligibility Representative - Accredo - Remote

The Cigna Group

1d • Remote

About The Position

The job profile for this position is Eligibility Representative, which is a Band 1 Professional Career Track Role. 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. 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.

Requirements

• High school diploma or GED required
• 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.

Nice To Haves

• bachelor’s degree preferred.
• Health care or professional office experience with medical insurance knowledge and terminology and experience in patient access preferred.
• Pharmacy/Specialty pharmacy experience a plus

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED