Role Description 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. Primary Responsibilities: - 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. Company Description 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.

• Send written correspondence and communicate with clients via phone to obtain, review and process enrollment materials for participants of CaliforniaChoice • Expert knowledge of all MPC Enrollment Rep I duties • Demonstrate knowledge of Correspondence duties as determined by department assessment as well as the following: • Understand company policies and procedures as they apply to CaliforniaChoice plans. • Responsible for the review and processing of the following forms including but not limited to: Employee Applications, Change Request Forms, Employee Termination Forms, Web Based Forms • Identify and obtain missing/incomplete information on forms based on guidelines and standard operating procedures. • Follow the department Pending Item process • Compose clear and concise written correspondence (i.e. pending item requests, denials, confirmations, memos, letters, etc.) • Place outbound calls to obtain missing/incomplete information on forms • Maintain working knowledge of all products and systems used for job function (i.e. Pegasus, doc-link, SharePoint, etc.) • Enter appropriate comments in a clear and succinct manner into Pegasus and/or Doc-Link. • Meet department standards for quality and quantity of work. • Maintain department and team standards for turnaround times. • Adhere to all PHI (Personal Health Information) guidelines • Assist with departmental training needs as needed • Onsite or remote regular attendance and punctuality are essential functions of the job. • Performs other business tasks or functions as assigned.

• Execute brand strategy and tactics in field, sales performance, effectively manage assigned territory and targeted accounts, build strong customer relationships and customer needs solving capability to maximize short and long term sales performance placing the patient into the center of any efforts and operating within AbbVie’s business code of conduct, policies and all applicable laws and regulations. • Deliver sales performance, brand KPIs, financial targets, marketing objectives, etc. in order to meet or exceed on those objectives. • Create pre-call plan using SMART objectives and execute post-call evaluation in order to continuously improve sales performance. • Effectively handle objections, misunderstandings, concerns and consistently gain logical and reasonable calls to action in order to close on every sales call. • Proactively and continuously aspire to serve customer needs, customer expectations and challenges in order to build trusted customer relationships and to achieve win-win agreements between AbbVie and customers. • Develop and execute a call plan that achieves set call metrics and optimizes coverage and frequency to key customers in order to maximize access and sales opportunities.

• Handle inbound and outbound customer service calls, including de-escalations to the best of your abilities with our clients placing their meal order • Address questions, and provide exceptional customer service • Input order information into the appropriate client order screen • Document all conversations with client into client information database • Ensure all assigned clients are contacted and have an order on file • Contact case managers via telephone, email, and/or fax when a special situation arises regarding one of their clients • Work quickly and efficiently without making the client feel rushed • Assisting clients with reships (after training is completed) • Assist callers who inquire about the Community Supports benefit, and submit a self-referral for those who meet the criteria to submit the referral. • Notify clients of benefits ending soon within the 30 day time frame, and offering to assist with reauthorization when able, or explain next steps for those whose agency does not allow Mom’s Meals to initiate the request • Explain benefits including nutritional counseling requirements and possible timelines for clients awareness