Remote Eligibility & Benefits Specialist

Cigna Healthcare; United States; À distance; USD 40 000 - 58 000; Plein temps

Résumé du poste

Evernorth Health Services, a division of The Cigna Group, is seeking an Eligibility Representative to support specialty patients with insurance coverage and benefits coordination. You’ll verify eligibility, gather benefit details, and help ensure timely access to medications.

Work from home nationwide, with remote eligibility work allowed in AL, IN, SC, or TN; strong attention to detail and communication with payers are essential for success in this role.

Qualifications

• One year of experience in eligibility verification or benefits investigation.
• Direct experience with insurance plans or payers, including outbound calls.
• Knowledge of PBM and medical benefits, ability to interpret plan details.
• Accurate documentation of insurance and authorization information.
• Ability to manage detailed, repetitive work with consistency.
• Strong written and verbal communication for payer interactions.
• High School Diploma or equivalent.
• Must live and work remotely in AL, IN, SC, or TN.

Responsabilités

• Review and interpret insurance eligibility, coverage details, and benefit limitations to determine clearance requirements.
• Initiate outbound communication with insurance plans and third-party payers to obtain benefit details, resolve coverage questions, and confirm authorization requirements.
• Navigate prior authorization processes by gathering required information and ensuring payer criteria are met accurately.
• Document benefit findings, authorization outcomes, and clearance decisions thoroughly and consistently within internal systems.
• Apply feedback and payer knowledge to continuously improve accuracy, efficiency, and overall clearance quality.

Connaissances

Eligibility verification

Benefits investigation

Prior authorizations

Payer communication

Detail oriented

Strong communication

Remote work availability

Formation

High School Diploma or equivalent

Description du poste

Evernorth Health Services, a division of The Cigna Group, is seeking an Eligibility Representative to support specialty patients with insurance coverage and benefits coordination. You’ll verify eligibility, gather benefit details, and help ensure timely access to medications.

Work from home nationwide, with remote eligibility work allowed in AL, IN, SC, or TN; strong attention to detail and communication with payers are essential for success in this role.