Eligibility Representative - Accredo - Remote

The Cigna Group

1d•Remote

About The Position

As an Eligibility Representative, you will play a critical role in helping patients gain access to life-saving medications by verifying insurance benefits, navigating coverage requirements, and providing exceptional support throughout the patient journey. This position combines customer service, problem-solving, and healthcare knowledge to ensure seamless experience for patients, providers, and internal partners.

Requirements

High school diploma or equivalent required.
Must have reliable high-speed internet through a wired connection (hotspots and mobile internet are not permitted).
Must maintain a private, distraction-free workspace while working remotely.
Ability to attend and successfully complete all required training during the first 90 days of employment.
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.

Nice To Haves

RxHome experience preferred
Previous experience in healthcare, medical insurance, patient access, eligibility verification, benefits investigation, or preferred related field.
Strong understanding of healthcare and medical insurance terminology.
Excellent verbal and written communication skills with a professional phone presence.
Ability to manage difficult conversations with professionalism, empathy, and confidence.
Strong attention to detail, organizational skills, and ability to multitask in a fast-paced environment.
Proficiency with computer applications and data entry.

Responsibilities

Handle approximately 10-15 inbound calls daily from patients and providers regarding claims, account inquiries, insurance coverage, and medication shipment coordination.
Complete an average of 25-35 outbound calls daily to insurance carriers, providers, patients, and internal partners.
Research and resolve patient claims and coverage issues using established processes and subject matter expertise.
Contact insurance providers to verify eligibility, benefits, coverage limitations, deductibles, copays, authorizations, and levels of care.
Perform detailed medical and pharmacy benefit investigations while applying payer-specific requirements and guidelines.
Coordinate with cross-functional teams to proactively address and resolve issues impacting referral turnaround times.
Collaborate with internal departments to gather and provide information needed to support patient access to therapy.
Ensure services provided are reimbursable and accurately documented in accordance with payer requirements.