Eligibility Representative - Accredo - Remote

Cigna Health and Life Insurance Company; Northern (KY); Hybrid; USD 36,000 - 48,000; Full time

Job summary

The Cigna Group's Evernorth Health Services seeks an Eligibility Representative to onboard patients for specialty pharmacy services. You’ll organize referral information, maintain records, and communicate with patients, prescribers, and providers to ensure smooth onboarding.

You will review referrals, evaluate documentation, resolve missing data, and support timely access to therapy while adhering to privacy standards and SOPs. This is a remote role in the United States.

Qualifications

• 1 year of healthcare or health insurance experience.
• 1 year of customer service experience.
• Ability to interpret pharmacy and medical plan details.
• Strong written and verbal communication for professional interactions.

Responsibilities

• Create and maintain complete patient profiles with demographic, prescription, and insurance data.
• Review, validate, and route referrals per intake workflows.
• Evaluate documentation to determine next steps and routing.
• Resolve missing or conflicting information to prevent delays.
• Communicate with patients, prescribers, and providers to facilitate timely access to therapy.
• Perform quality checks and maintain documentation while following SOPs and privacy standards.
• Manage a high volume of referrals while meeting productivity and accuracy goals.

Skills

Attention to detail

Data accuracy

Medical terminology

Verbal communication

Written communication

Organization

Research skills

Problem solving

Confidentiality

Education

High School Diploma or equivalent

Job description

As an Eligibility Representative, you’ll play an essential role in onboarding patients who need specialty pharmacy services. You’ll organize referral information, maintain complete records, and communicate with patients, prescribers, and healthcare providers. Your work will help reduce delays, improve care coordination, and create a smooth, dependable onboarding experience. Here’s a little more on how you’ll make a difference:

PRIMARY RESPONSIBILITIES:

• Create and maintain complete patient profiles by accurately entering and updating demographic, prescription, insurance, prescriber, and relevant clinical information in internal systems.
• Review, validate, classify, and route incoming referrals and supporting documents according to established intake workflows and case requirements.
• Evaluate referral and prescription documentation, using knowledge of specialty medications, therapies, and treatment categories to determine next steps and appropriate case routing.
• Research and resolve missing, incomplete, or conflicting patient, prescriber, insurance, prescription, and clinical information to prevent processing delays.
• Communicate and collaborate with patients, prescribers, clients, healthcare providers, insurance representatives, and internal partners to complete referrals, remove barriers, and support timely access to therapy.
• Perform quality checks and complete required documentation, system updates, corrective actions, and task handoffs while following Standard Operating Procedures, regulatory requirements, and privacy standards.
• Manage a high volume of referrals while consistently meeting productivity, accuracy, quality, and turnaround-time expectations.

KEY SKILLS AND COMPETENCIES

• Attention to detail and data accuracy
• Knowledge of medical, pharmacy, insurance, and specialty therapy terminology
• Ability to interpret referrals, prescriptions, insurance, and clinical documents
• Clear communication and patient-focused service
• Organization, research, and problem-solving skills
• Ability to prioritize work and meet performance expectations
• Commitment to quality, confidentiality, and compliance

QUALIFICATIONS:

• Minimum of 1 year of experience in a healthcare or health insurance setting
• Minimum of 1 year of customer service experience
• Working knowledge of pharmacy (PBM) benefits and medical benefits, with the ability to interpret plan details accurately.
• Ability to manage detailed, repetitive work in a structured environment while maintaining consistency and quality.
• Strong written and verbal communication skills appropriate for professional interactions with payer representatives.
• High School Diploma or equivalent.
• Must live and work remotely in one of the following states: South Carolina or Arizona
• 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.

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.

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.