Eligibility Representative- Evernorth- Remote
About The Position
At Evernorth Health Services, we believe access to care starts with clarity, compassion, and trust. As an Insurance Eligibility Representative, you play a critical role in helping patients understand their coverage and financial responsibility so they can focus on their health with confidence. Supporting CarepathRx within our Pharmacy and Care Delivery organization, you will partner with patients, payers, and care teams to ensure accurate insurance verification and a smooth reimbursement experience. This role is ideal for someone who is detail-oriented, patient-focused, and motivated to grow their expertise in specialty pharmacy and infusion services. Schedule: Monday–Friday, 8:00 AM–6:00 PM EST (rotating shifts)
Requirements
- High school diploma or GED
- Minimum 1 year of experience in insurance verification, prior authorization, or related reimbursement work within a healthcare setting
- Working knowledge of medical terminology
- Proficient computer skills, including Microsoft Office products
- Strong math skills with attention to detail
- Clear written and verbal communication skills
- Strong organization and time management abilities
Nice To Haves
- Experience navigating payer websites and eligibility systems
- Understanding of coordination of benefits
- Knowledge of pharmacy versus medical benefit payers
- Familiarity with prior authorization requirements and plan formularies
- Experience supporting specialty pharmacy or infusion services
Responsibilities
- Deliver accurate and timely insurance eligibility verification to support patient access to specialty pharmacy and infusion services
- Translate insurance benefits into clear cost estimates and coverage explanations for patients and care teams
- Create and maintain complete, accurate patient profiles, including demographics, insurance details, and authorization status
- Generate financial responsibility letters and review benefits with patients by phone in a supportive, easy-to-understand manner
- Secure prior authorizations and required payer documentation to prevent delays in care
- Coordinate financial assistance applications, payment agreements, and required waivers
- Monitor reimbursement activity, identify issues early, and assist with research to support resolution
- Collaborate with internal partners to ensure a seamless patient and client experience
- Maintain productivity, quality, and accuracy standards while managing multiple priorities
- Demonstrate accountability, follow-through, and pride in delivering reliable, high-quality work
- Contribute to continuous improvement by sharing insights and supporting efficient reimbursement workflows
Benefits
- 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 and paid holidays.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
