Eligibility Senior Representative - Accredo - Remote

Do you want to Drive Growth and Improve Lives? Accredo a division of The Cigna Group is hiring several Eligibility Senior Representatives to implement and maintain eligibility of benefits for our patients with Blood Disorders. In this very specialized role, you’ll be responsible to update, and maintain automated, direct connect and/or manual eligibility data. You’ll Interact with internal partners, external clients, and vendors. You’ll generate reports to identify and resolve discrepancies. Identify process improvement opportunities. May negotiate and resolve eligibility with clients. May provide technical support for the electronic processing of eligibility. Ensures customer data is installed accurately and timely. Acts as a liaison between both internal and external resources to facilitate the timely processing of referrals and provide accurate status reporting to clients.

How you’ll make a difference:

• Facilitates cross-functional resolution of drug coverage issues and proactively addresses, researches and resolves issues impacting revenue optimization
• Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients
• Contact benefit providers to gather policy benefits/limitations
• Coordinate and ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.)
• Directly interfaces with external clients, providing expert assistance to clients on patient status
• Liaison for company providing referral status reporting
• May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome
• Handle Escalations
• Use discretion and independent judgement in handling pt or more complex client complaints, escalating as appropriate.
• Completes other projects and additional duties as assigned

What you need to be successful:

• High school diploma or GED required, bachelor’s degree preferred
• 3+ years of health care experience with medical insurance knowledge, terminology and patient access preferred
• Intermediate data entry skills and working knowledge of Microsoft Office, Excel and Outlook, Required
• Extensive knowledge of ESI products and services preferred
• Experience training and coaching less experienced staff with patience to explain details and processes repeatedly required
• Excellent phone presentation and communication skills
• Demonstrated ability to handle challenging customers and escalated situations/ calls, in a professional manner
• Ability to adapt in a changing environment and make decisions with minimal supervision
• Self-Starter with advanced problem-solving skills and the ability to work collaboratively with other departments and provide 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.

For this position, we anticipate offering an hourly rate of 18 - 27 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. That’s why you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

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: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.