Eligibility Senior Representative - Accredo

Cigna; United States; Remote; USD 45,000 - 70,000; Full time

Job summary

A leading health services organization seeks an Eligibility Senior Representative to manage complex patient access functions and ensure effective communication across all stakeholders. This position plays a pivotal role in facilitating drug coverage and resolving claims, contributing to better patient experiences.

Qualifications

• At least 2-3 years of related working experience.
• Must have healthcare experience with medical insurance knowledge.
• Solid understanding of patient access processes.

Responsibilities

• Facilitate cross-functional resolution of drug coverage issues.
• Independently resolve basic patient claims issues.
• Contact benefit providers to gather policy benefits.

Skills

Communication skills

Problem-solving skills

Data entry skills

Education

High school diploma or GED required, bachelor’s degree preferred

Job description

Eligibility Senior Representative - Accredo

Pay Competitive

Location Remote

Employment type Full-Time

Job Description

Req#: 25007875

Job Description:

The Eligibility Senior Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes to successfully liaise 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 company goals and the patient experience. Acts as a liaison between both internal and external resources to reduce client abrasion and facilitate the timely processing of referrals. This individual can proactively recognize cause and effect trends, identify and clarify patients’ needs, and work towards solutions.

ESSENTIAL FUNCTIONS:

• 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 claim s 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.

• 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.


JOB QUALIFICATIONS:

• High school diploma or GED required, bachelor’s degree preferred

• At least 2-3 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.

ABOUT THE DEPARTMENT:

Through our range of health care products and services offered, Accredo team members provide in-depth care for patients with chronic health conditions like hemophilia, oncology, rheumatoid arthritis and growth hormone deficiency. In addition to health care products, we provide comprehensive management services – including outcomes measurement, counseling, clinical care management programs, social services, and reimbursement services. By performing in these very high-touch roles, employees have a daily opportunity to make a positive impact on their patients’ lives.

NOTE : This is a work at home position, and you will be required to have reliable internet connectivity provided through a wired connection. A mobile or hot spot environment is not acceptable and you may need to purchase an Ethernet cord depending on your current set up.


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: [e-mail] for support. Do not email [e-mail] 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.

About the company

Cigna is an American worldwide health services organization based in Bloomfield, Connecticut.

Notice

Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

Talentify provides reasonable accommodations to qualified applicants with disabilities, including disabled veterans. Request assistance at [e-mail] or 407-000-0000.

Federal law requires every new hire to complete Form I-9 and present proof of identity and U.S. work eligibility.

An Automated Employment Decision Tool (AEDT) will score your job-related skills and responses. Bias-audit & data-use details: www.talentify.io/bias-audit-report . NYC applicants may request an alternative process or accommodation at [e-mail] or 407-000-0000.