Eligibility Senior Representative
The Cigna Group
•Remote
About The Position
The Eligibility Senior Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and processes to successfully communicate with Payers, Pharma, Physicians, and Patients. Relies on experience and knowledge of industry best practices to communicate knowledge of pending referrals that may have an adverse impact on the patient experience. This individual can proactively recognize trends, identify and clarify patients’ needs, and work towards solutions.
Requirements
- High school diploma or GED required
- At least 2+ years of related working experience.
- Must have Health care experience with medical insurance knowledge and terminology and experience in patient access.
- Intermediate data entry skills and working knowledge of Microsoft Office.
- Excellent phone presentation and communication skills.
- Demonstrated ability to handle professionally challenging customers.
- Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
- Advanced 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
Responsibilities
- Facilitate cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time.
- Independently resolve basic patient claims issues using key subject matter knowledge.
- Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates, and authorizations.
- Effectively collaborate with internal departments to resolve issues or provide any needed information, always using professional communication.
- Contact benefit providers to gather policy benefits/limitations.
- Perform medical /pharmacy benefits verification requiring complex decision skills based on payer and process knowledge.
- Complete other projects and additional duties as assigned.
Benefits
- The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
High school or GED
