Role Description The job profile for this position is Eligibility Representative, which is a Band 1 Professional Career Track Role. As an Eligibility Representative, you’ll be part of a dedicated team which helps our specialty pharmacy patients coordinate their medication needs and pharmacy insurance coverage for complex medical conditions. This role handles each inquiry with care, detail, and most importantly, empathy. Here’s a little more on how you’ll make a difference: - Review and interpret insurance eligibility, coverage details, and benefit limitations to determine clearance requirements. - Initiate outbound communication with insurance plans and third-party payers to obtain benefit details, resolve coverage questions, and confirm authorization requirements. - Navigate prior authorization processes by gathering required information and ensuring payer criteria are met accurately. - Document benefit findings, authorization outcomes, and clearance decisions thoroughly and consistently within internal systems. - Apply feedback and payer knowledge to continuously improve accuracy, efficiency, and overall clearance quality. Qualifications - Minimum of 1 year of experience in a healthcare or health insurance setting performing eligibility verification, benefits investigation, prior authorizations, or patient access support. - Direct experience working with insurance plans or payers, including outbound calls to obtain or clarify coverage information. - Working knowledge of pharmacy (PBM) benefits and medical benefits, with the ability to interpret plan details accurately. - Experience documenting insurance and authorization information with a high level of accuracy and attention to detail. - Ability to manage detailed, repetitive work in a structured environment while maintaining consistency and quality. - Strong written and verbal communication skills appropriate for professional interactions with payer representatives. - High School Diploma or equivalent. - Must live and work remotely in one of the following states: Alabama, Indiana, South Carolina, or Tennessee. - 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. Requirements - 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.

• Facilitate the resolution of insurance and patient credit balances to ensure patient satisfaction and compliance with federal or state regulations. • Must have strong attention to detail and accuracy partnered with strong problem solving skills. • Document and resolve outstanding unidentified credit balances. • Receive incoming refund requests or correspondence and work to resolve and return credit balances to the appropriate entity. • Identify trends in credit balances and work with supervisor to resolve overpayments. • Review credit balances on accounts to resolve by correction, refund or inquiry. • Work closely with both internal and external customers. • Provide assistance to other departments on demand regarding inquiries on credit balances. • Extensive use of electronic billing systems. • Plan, prioritize, organize and complete work to meet established production goals, quotas and deadlines in a fast pace and ever changing environment. • Must demonstrate critical thinking skills to manage day-to-day basic operations. • Must be able to do work steadily, efficiently and show constant vigilance to the details of the work. • Must have good working knowledge of all insurance and government rules regarding payment, credit procedures, claims submittal and appeal processes. • Comply with all regulatory bodies and agencies. • Must be able to use appropriate reference materials when needed. • Clear understanding of the impact payment applications and refund/credit processing has on revenue cycle operations and financial performance.

• Work effectively in an independent sales environment to generate new business sales activity • Market and generate new sales of insurance products through new or lapsed agents/brokers • Own the recruiting, new business generation and sales strategies • Work closely with members in the new business and service teams to ensure continued growth of new sales • Conduct regular follow-up calls to agents/brokers to maintain quote activity • Resolve conflicts, solve problems, and provide feedback to management

• Review and interpret insurance eligibility, coverage details, and benefit limitations to determine clearance requirements. • Initiate outbound communication with insurance plans and third‑party payers to obtain benefit details, resolve coverage questions, and confirm authorization requirements. • Navigate prior authorization processes by gathering required information and ensuring payer criteria are met accurately. • Document benefit findings, authorization outcomes, and clearance decisions thoroughly and consistently within internal systems. • Apply feedback and payer knowledge to continuously improve accuracy, efficiency, and overall clearance quality.