Eligibility Senior Representative - Accredo - Remote

Cigna Healthcare • Pennsylvania Work at Home, IN

1d • Remote

About The Position

Join the Advanced Therapy New Referrals team and help patients access complex therapies with confidence. In this role, you will review benefits, resolve coverage questions, and work with patients, providers, payers, and internal partners to move referrals forward. You will use critical thinking, accuracy, and clear communication to support a smooth experience and help patients understand their coverage and financial options.

Requirements

• High school diploma or equivalent.
• Minimum of 1 year of experience in healthcare, specialty pharmacy, patient access, reimbursement, insurance verification, or a related field.
• Knowledge of insurance eligibility, coverage requirements, reimbursement processes, prior authorization, or payer requirements.
• Strong attention to detail, problem-solving skills, and ability to manage multiple priorities while maintaining accuracy.
• Clear verbal and written communication skills with the ability to explain coverage and financial information in a professional way.
• Ability to use computer systems and accurately document work.

Nice To Haves

• Experience conducting medical and pharmacy benefit investigations.
• Experience supporting specialty pharmacy, patient access, reimbursement, or new referral intake workflows.
• Experience working with complex medical and pharmacy benefit structures or payer requirements.
• Knowledge of specialty drug reimbursement, copay assistance, manufacturer support programs, or patient assistance programs.

Responsibilities

• Conduct medical and pharmacy benefit investigations to confirm eligibility, coverage, payer requirements, and patient financial responsibility.
• Verify insurance eligibility, benefit details, coverage limitations, and documentation requirements to support timely referral processing.
• Identify prior authorization, appeal, step therapy, quantity limit, and other utilization management requirements that may affect access to therapy.
• Research and resolve complex reimbursement, eligibility, and coverage issues by working with payers, providers, patients, and internal partners.
• Educate patients on copay, coinsurance, and financial responsibility, and assist with enrollment in available copay assistance, manufacturer support programs, and patient assistance programs, as applicable.
• Document referral activity accurately in company systems and follow departmental procedures to support service, quality, and compliance expectations.
• Monitor assigned referrals, manage escalations, and help reduce delays in therapy initiation and treatment continuity.

Benefits

• 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.

What This Job Offers

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