Job Description
Ready to improve the health and Vitality of those we serve? Accredo, a line of business within the Cigna Group is hiring an Eligibility Senior Representative. For this crucial role, you'll perform patient access / eligibility functions requiring an advanced understanding of insurance benefits and internal processes. You'll liaise with Payers, Pharma, Physicians, and Patients, to ensure our patients get their medication authorized for payment.
What you'll do to make a difference: - Deliver straightforward administrative and/or other basic business services in Eligibility Implements and maintains eligibility for benefits
- Ensures customer data is input accurately and timely
- Contacts benefit providers to gather policy benefits/limitations to ensure re-authorization of prescription mediations
- Coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.)
- Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge
- Provide expert assistance to internal and external clients on patient status
- Handle Escalations with expert understanding on department policies and procedures
- Use discretion & independent judgement in handling patient or more complex client complaints, escalating as appropriate and when to triage as needed
What you'll need to succeed: - High school diploma or GED required
- 1+ years of experience with medical insurance eligibility and prior authorization strongly preferred
- 2 + years of Health care experience, medical terminology and experience in patient access, strongly preferred
- Intermediate data entry skills with Microsoft Office; Outlook and Excel, required
- Knowledge of ESI / Accredo products and services, strongly preferred
- Professional phone presentation and communication skills, required
- 2 + years of experience handling challenging situations in a professional manner, required
- 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
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.
About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.
If you require reasonable accommodation in completing the online application process, please email:
[email protected] for support. Do not email
[email protected] for an update on your application or to provide your resume as you will not receive a response.
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. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.
Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
Job Tags
Permanent employment, Local area, Remote job,