Eligibility Senior Representative - WeCARE

Job Description Summary

This is a cross-functional eligibility representative position focusing on all aspects of eligibility from initial benefits investigation to point of sale same day shipping.

The role is ideal for team players with a willingness to learn new skills and develop processes related to cross-training for streamlining the eligibility process to quickly serve the needs of our patients.

• We are looking for a variety of skills across the team, including a mixture of the following skills and/or experience:
• RxHome and CareCentral trained
• Escalation Management
• Clearance New Referral
• Prior Authorization / Re-Authorization
• Rejection Handling
• Same Day
  • This team continuously adapts, and cross-training will be implemented to achieve versatility in meeting business needs.

As a member of this team, you’ll collaborate directly with pharmacists, technicians, and contact center representatives to quickly resolve orders. This includes making outbound calls to providers, patients, and payers. There is currently no expectation for handling inbound phone calls.

Job Profile Summary

Delivers specific delegated Eligibility tasks assigned by a supervisor. Implements, updates, and maintains automated, direct connect and/or manual eligibility data. May handle National Accounts or more complex accounts. Reconciles accounts for non-standard requests. May provide technical support for the electronic procession of eligibility. Ensures customer data is installed accurately and timely. Analyzes formats that are customized directly by the client. May work directly with Systems to design formats. Provides recommendations to decrease errors. Thorough technical knowledge of manual and automated eligibility. Completes day-to-day Eligibility tasks without immediate supervision, but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members.

Job Description

Express Scripts and Accredo Specialty Pharmacy are now part of Cigna. Together, we have got big plans. 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, Patient Access, Accredo on the WeCARE team, 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 such as HIV, rheumatoid arthritis, and more.  This role is on the front lines with patients and doctors offices, responding to phone inquiries and addressing each with care, detail, and most importantly, empathy.

Here’s a little more on how you’ll make a difference: 

• Help patients get the medication they need. Use the knowledge you gain from training, your problem-solving skills and support from your team to answer patient calls effectively.  You’ll coordinate and ensure services are covered under insurance coverage and talk to patients about their deductibles, co-payments, and authorizations.  
• Interact directly with healthcare providers.  You’ll research issues on benefits coverage with pharmacist and doctors’ office and provide guidance to our patients about medication coverage.  
• Juggle multiple tasks without sacrificing attention to detail.  You will be busy handling multiple requests at any given time as well as documenting information from your conversations in our computer system.   

What You Should Have: 

• High School Diploma / GED required, a bachelor’s degree is preferred.  
• Customer Service experience 
• Health care experience with knowledge of medical insurance and terminology is preferred and will make you successful in this role! 
• General PC knowledge including experience working with Microsoft Office 
• Excellent communication skills (verbal and written) 
• Must have RX Home and Care Central Experience
• Clearance knowledge preferred

What you’ll love about working here: 

• Fun, friendly, and unique culture – Bring your whole self to work every day! 
• Choice of three unique medical plans 
• Prescription Drug, Dental, Vision and Life Insurance 
• Employee Contributions for HRA and HSA accounts 
• 401K with Company Match
• Paid Time Off and Paid Holidays 
• Tuition Assistance

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 - 28 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.

We want you to be healthy, balanced, and feel secure. That’s why 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) with company match, 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, visit Life at Cigna Group.

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 require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com for an update on your application or to provide your resume as you will not receive a response.

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.