Prior Authorization Representative

Prior Authorization Representative - Express Scripts - Remote

Department - CRD (Coverage Review Department)

SUMMARY

The Cigna Group is a global health Service Company dedicated to helping people improve their health and vitality. “Prior authorization” refers to a process that is used to determine if a prescribed procedure, service, or medication is covered by a member’s current healthplan. As a Prior Authorization Representative, you’ll be in a call center environment, and a part of a dedicated team that provides information regarding pharmacy benefits and drug coverage. This crucial role is on the front lines with patients, pharmacists, and doctors' offices, responding and addressing each phone inquiry with care, detail, and most importantly, empathy.

RESPONSIBILITIES

• Handle inbound telephone and written inquiries from pharmacists and doctors regarding Prior Authorizations by screening and reviewing requests based on benefit plan design, client specifics and clinical criteria to determine coverage eligibility.
• Facilitate resolution of drug coverage issues and pro-actively address, research, and resolve issues while maintaining accurate and complete documentation of all inquiries for continuous improvement.
• Spend about 60% of your time answering an average of 20-40 inbound calls a day, 30% of your time handling faxes, and about 10% of your time sorting.
• Use 3 systems daily, which you will be trained on, to complete your work
• Availability to attend 100% training and the first 90 days of employment.

QUALIFICATIONS

• High School diploma or equivalent
• 2 – 3 years of experience
• Conflict resolution skills
• Excellent organizational skill
• Superior written and verbal communication and presentation skills
• Strong interpersonal skills
• Ability to handle challenging customers in a professional manner
• Ability to adapt in a dynamic work environment learns quickly, solve problems, and make decisions
• Willingness to work a flexible schedule for peak call times
• Private & quiet workspace.

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 17 - 25 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 The Cigna Group

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.

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.