Job Closed

This listing is no longer active.

Eligibility Senior Representative

Customer SupportCustomer SupportFull TimeRemoteSeniorTeam 10,001+Since 1982H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

74 days ago

Salary

$19 - $29 / hour

Seniority

Senior

No structured requirement data.

Job Description

Eligibility Senior Representative

The Cigna Group

Job Description: The Eligibility Senior Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and processes to successfully communicate with Payers, Pharma, Physicians, and Patients. Relies on experience and knowledge of industry best practices to communicate knowledge of pending referrals that may have an adverse impact on the patient experience. This individual can proactively recognize trends, identify and clarify patients’ needs, and work towards solutions.  ESSENTIAL FUNCTIONS: - Facilitate 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, always using professional communication. - Contact benefit providers to gather policy benefits/limitations.  - Perform medical /pharmacy benefits verification requiring complex decision skills based on payer and process knowledge. - Complete other projects and additional duties as assigned.  JOB QUALIFICATIONS: - High school diploma or GED required, bachelor’s degree preferred - At least 2+ years of related working experience. - Must have Health care experience with medical insurance knowledge and terminology and experience in patient access. - Intermediate data entry skills and working knowledge of Microsoft Office. - Excellent phone presentation and communication skills. - Demonstrated ability to handle professionally challenging customers. - Ability to adapt in a dynamic work environment and make decisions with minimal supervision. - Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions. ABOUT THE DEPARTMENT: Through our range of health care products and services offered, Accredo team members provide in-depth care for patients with chronic health conditions like hemophilia, oncology, rheumatoid arthritis and growth hormone deficiency. In addition to health care products, we provide comprehensive management services – including outcomes measurement, counseling, clinical care management programs, social services, and reimbursement services. By performing in these very high-touch roles, employees have a daily opportunity to make a positive impact on their patients’ lives. 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 19 - 29 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. At The Cigna Group, 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), 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, click here. 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 need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. 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. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Related Job Pages

More Customer Support Jobs

Full TimeRemoteTeam 10,001+Since 1890H1B No Sponsor

City/State Virginia Beach, VA Work Shift First (Days) Overview: Sentara Health is currently seeking a full-time remote Customer Service Representative. Position Status: Full-time, Day Shift Position Location: This is a remote position however, candidates must reside in Virginia and North Carolina. You must be able to travel on-site if you have connectivity issues and trainings at needed bases. Standard Working Hours: Must be able to work between the hours of 8:00AM to 4:30PM The Customer Service Representative is responsible for all areas of customer service as it pertains to research and resolution of telephone inquiries from members or patients. Primarily responsible for handling incoming calls to effectively address issues related to either member eligibility, plan prescription benefits, and claim payment issues or patient services needs such as updating billing information, establishing payment plans, resolving payment inquiries, or patient scheduling. Education - High school diploma or equivalent Required Experience - Two years of customer service experience required - Previous data entry experience required - Prior scheduling experience required - Experience in a high-volume call center preferred . Benefits: Caring For Your Family and Your Career • Medical, Dental, Vision plans • Adoption, Fertility and Surrogacy Reimbursement up to $10,000 • Paid Time Off and Sick Leave • Paid Parental & Family Caregiver Leave • Emergency Backup Care • Long-Term, Short-Term Disability, and Critical Illness plans • Life Insurance • 401k/403B with Employer Match • Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education • Student Debt Pay Down – $10,000 • Reimbursement for certifications and free access to complete CEUs and professional development • Pet Insurance • Legal Resources Plan • Colleagues may have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met Sentara Independence provides quality outpatient services to the surrounding community. The facility includes an ambulance-accessible emergency room that is supported by board-certified physicians. Sentara Independence houses state-of-the-art medical equipment and highly-skilled physicians and staff. Sentara Independence is now an extension of the quality services at Sentara Virginia Beach General Hospital including advanced imaging and physical therapy. Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. In support of our mission “to improve health every day,” this is a tobacco-free environment. For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

United States
Job Closed
Full TimeRemoteTeam 10,001+Since 1890H1B No Sponsor

• Responsible for all areas of customer service related to telephone inquiries from members or patients. • Handle incoming calls to effectively address issues related to member eligibility, plan prescription benefits, claims payment, or patient services needs. • Provide quality service and customer satisfaction through effective communication and education.

Virginia
Job Closed

Job Overview: We are seeking a detail-oriented and service-focused Remote Vacation Services Coordinator to support clients with vacation-related coordination and booking assistance in a remote environment. This role centers on organization, communication, and administrative support to ensure a smooth and professional client experience. This position is well suited for individuals who are organized, reliable, and comfortable working independently using digital tools. Key Responsibilities: Provide support for vacation planning and reservation requests Assist with coordinating accommodations, scheduling, and related services Maintain accurate client records and documentation in internal systems Communicate professionally with clients via email, phone, and online platforms Review confirmations and service details for accuracy and completeness Provide general customer service and administrative support Follow established workflows and internal procedures Collaborate with internal teams to support client needs and timelines Qualifications: Strong written and verbal communication skills Excellent organizational skills and attention to detail Comfortable working with online systems and digital platforms Ability to manage multiple tasks in a remote environment Customer service, scheduling, or administrative experience preferred Reliable internet access and ability to work remotely Work Environment: Fully remote position Structured and supportive team environment Training and resources provided $45,000 - $65,000 a year

United States
$45K - $65K / year
Job Closed

Job Title: Online Virtual Scheduling Assistant – Remote Company: Destination Knot About Us: Destination Knot is a dynamic travel company committed to delivering seamless and personalized travel planning experiences. We specialize in luxury vacations, destination weddings, honeymoons, cruises, and family getaways. Our team thrives on organization, service, and a shared love of travel. Job Description: We are looking for a reliable and detail-oriented Online Virtual Scheduling Assistant to support our team of travel advisors. This fully remote role is perfect for someone who excels in time management, calendar coordination, and client communication. You will play a key role in ensuring appointments, consultations, and travel timelines are smoothly managed. Key Responsibilities: Coordinate and manage calendars for multiple travel advisors Schedule client consultations and supplier meetings Send reminders and follow-ups for scheduled appointments Track and organize important deadlines and travel milestones Support trip timeline management (e.g., payment schedules, document delivery dates) Communicate professionally with clients and team members Qualifications: Strong time management and organization skills Excellent written and verbal communication Comfortable using Google Calendar, scheduling tools, and email platforms Ability to multitask and work independently in a remote setting Prior experience in scheduling, admin, or customer service is a plus Enthusiasm for travel is a bonus but not required What We Offer: Remote, flexible work schedule ideal for work-life balance Training and ongoing support from a collaborative team Income-earning potential through administrative project support and performance-based incentives Growth pathways into roles in travel planning or operations Access to travel industry benefits and discounts following completion of training How to Apply: If you love staying organized, enjoy helping others succeed, and want a flexible remote role in a growing travel company, we’d love to hear from you. Apply today and join the Destination Knot team! $40,000 - $65,000 a year

United States
$40K - $65K / year
Job Closed