Cigna Hiring for Eligibility Representative – Work from home, TN, MS- Accredo at Hartford, CT Full Time

Delivers straightforward administrative and/or other basic business services in Eligibility. Implements and maintains eligibility for benefits. Implements, updates, and maintains automated, direct connect and/or manual eligibility data. Interacts with internal partners and/or external clients/vendors. Generates reports to identify and resolve discrepancies. Identifies process improvement opportunities for own cases. 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. May work with client’s format and internal Systems to resolve errors. May interact with Systems to resolve technical issues. General knowledge of manual and automated eligibility. Familiar with reporting tools. Technical understanding of systems. Issues tend to be routine in nature. Good knowledge and understanding of Eligibility and business/operating processes and procedures. Works to clearly defined procedures under close supervision.

Have you heard? Express Scripts and Accredo are now part of Cigna. Together, we’ve got big plans. How big, you ask? We want to change health care to make it more affordable, more personalized, and more focused on helping the whole person to achieve better health outcomes. And that’s only the beginning. Read on to learn more about working with us.

As an Eligibility Representative , you will be part of a team passionate about helping our patients with billing and ensuring their access to life saving medications.

What you’ll do:
Facilitates 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 claims 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

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.)

Perform medical/pharmacy benefit verification requiring complex decision skills based on payer and process knowledge

What you’ll need:
High school diploma or GED

3-5 years of relevant working experience

Experience with health care, medical insurance terminology and patient access preferred

Strong data entry skills and computer skills

Excellent phone presentation and communication skills

Demonstrated ability to handle difficult conversations in a professional manner

Ability to adapt in a dynamic work environment and make decisions independently

Advanced problem solving skills and the ability to work collaboratively with other departments

NOTE : We are currently training in a work at home environment, 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.

This position is not eligible to be performed in Colorado.

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

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: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.