Senior Patient Access & Benefits Specialist

UnitedHealth Group; United States; Hybrid; USD 26,000 - 40,000; Full time

Benefits offered by this job

Annual bonus plan

Health benefits

401(k)

Job summary

The Cigna Group's Evernorth Health Services division seeks an Eligibility Senior Representative to help patients access required medications by navigating insurance benefits and payer requirements. You will communicate updates on referrals and resolve issues to improve patient experience.

A strong healthcare background and insurance knowledge are essential. Responsibilities include resolving drug coverage issues, reviewing claims for payer alignment, and collaborating with internal teams.

Qualifications

• High school diploma or GED required.
• At least 2+ years of related working experience.
• Healthcare experience with medical insurance knowledge and terminology, and patient access experience.
• Intermediate data entry skills and working knowledge of Microsoft Office.
• Excellent phone presentation and communication skills.
• Ability to handle challenging customer situations professionally.
• Ability to adapt in a dynamic environment and make decisions with minimal supervision.
• Advanced problem-solving skills with cross-department collaboration.

Responsibilities

• Facilitate cross-functional resolution of drug coverage issues and address referral turnaround time.
• Independently resolve basic patient claims issues using key subject matter knowledge.
• Prepare and review claims to align with payer requirements (codes, dates, authorizations).
• Collaborate with internal departments to resolve issues with professional communication.
• Contact benefit providers to gather policy benefits and limitations.
• Perform medical/pharmacy benefits verification requiring complex decision-making.
• Complete other projects and duties as assigned.

Skills

Communication

Data entry

Microsoft Office

Phone skills

Problem solving

Adaptability

Education

High school diploma or GED

Job description

The Cigna Group's Evernorth Health Services division seeks an Eligibility Senior Representative to help patients access required medications by navigating insurance benefits and payer requirements. You will communicate updates on referrals and resolve issues to improve patient experience.

A strong healthcare background and insurance knowledge are essential. Responsibilities include resolving drug coverage issues, reviewing claims for payer alignment, and collaborating with internal teams.