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Eligibility Representative- Evernorth- Remote
Location
United States
Posted
65 days ago
Salary
$17 - $26 / hour
Seniority
Mid Level
No structured requirement data.
Job Description
Eligibility Representative- Evernorth- Remote
The Cigna Group
The job profile for this position is Eligibility Representative, which is a Band 1 Professional Career Track Role. Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply! Our people make all the difference in our success. Eligibility Representative-Evernorth (CarePathRx) Position Overview At Evernorth Health Services, we believe access to care starts with clarity, compassion, and trust. As an Insurance Eligibility Representative, you play a critical role in helping patients understand their coverage and financial responsibility so they can focus on their health with confidence. Supporting CarepathRx within our Pharmacy and Care Delivery organization, you will partner with patients, payers, and care teams to ensure accurate insurance verification and a smooth reimbursement experience. This role is ideal for someone who is detail-oriented, patient-focused, and motivated to grow their expertise in specialty pharmacy and infusion services. Schedule: Monday–Friday, 8:00 AM–6:00 PM EST (rotating shifts) Key Responsibilities • Deliver accurate and timely insurance eligibility verification to support patient access to specialty pharmacy and infusion services • Translate insurance benefits into clear cost estimates and coverage explanations for patients and care teams • Create and maintain complete, accurate patient profiles, including demographics, insurance details, and authorization status • Generate financial responsibility letters and review benefits with patients by phone in a supportive, easy-to-understand manner • Secure prior authorizations and required payer documentation to prevent delays in care • Coordinate financial assistance applications, payment agreements, and required waivers • Monitor reimbursement activity, identify issues early, and assist with research to support resolution • Collaborate with internal partners to ensure a seamless patient and client experience • Maintain productivity, quality, and accuracy standards while managing multiple priorities • Demonstrate accountability, follow-through, and pride in delivering reliable, high-quality work • Contribute to continuous improvement by sharing insights and supporting efficient reimbursement workflows Qualifications Required Qualifications • High school diploma or GED • Minimum 1 year of experience in insurance verification, prior authorization, or related reimbursement work within a healthcare setting • Working knowledge of medical terminology • Proficient computer skills, including Microsoft Office products • Strong math skills with attention to detail • Clear written and verbal communication skills • Strong organization and time management abilities Preferred Qualifications • Experience navigating payer websites and eligibility systems • Understanding of coordination of benefits • Knowledge of pharmacy versus medical benefit payers • Familiarity with prior authorization requirements and plan formularies • Experience supporting specialty pharmacy or infusion services About CarepathRx at Evernorth As part of Evernorth Health Services, CarepathRx partners with hospitals and health systems to deliver specialty pharmacy and infusion services that improve outcomes and elevate the patient experience. Our teams are ambitious, compassionate experts committed to learning, growing, and making healthcare simpler and more human every day. 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 - 26 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. 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.Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.
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