Eligibility Senior Representative - Accredo - Remote

Help patients receive important therapy without unnecessary delays. In this role, you will use your knowledge of insurance, reimbursement, payer requirements, and pharmacy operations to clear patient accounts for medication shipment. You will partner with internal teams, payers, providers, pharmacies, and manufacturer contacts to remove barriers, support timely treatment, and improve the patient experience.

Responsibilities

Review patient accounts, insurance requirements, authorization status, and coverage details to determine shipment readiness.

Identify and resolve barriers that may prevent medication shipment, including claim rejections, reimbursement issues, benefit concerns, and payer requirements.

Coordinate the activities needed to clear patients for shipment, including benefit review, claim resolution, authorization validation, and payer requirement review.

Research coverage and reimbursement challenges and use sound judgment to determine next steps, escalation needs, and resolution plans.

Partner with pharmacy operations, patient access teams, healthcare providers, payers, manufacturers, and internal stakeholders to support timely shipment outcomes.

Escalate high-risk shipment barriers that could cause therapy interruption, delayed treatment, patient dissatisfaction, or financial impact.

Communicate shipment status, issue resolution, and trends clearly and professionally to business partners and external contacts.

Serve as a subject matter resource for complex shipment clearance questions, insurance requirements, and patient access barriers.

Support process improvements, training, best-practice sharing, and special projects that improve shipment clearance and patient access outcomes.

Required qualifications

Must be able to work Monday - Friday 11:00AM - 8:00PM EST

High school diploma or GED.

Minimum of 3 years of experience in healthcare, specialty pharmacy, patient access, insurance verification, reimbursement, revenue cycle management, or a related field.

Knowledge of medical or pharmacy insurance benefits, authorization requirements, payer requirements, claims, and reimbursement processes.

Strong problem-solving and analytical skills, with the ability to research complex issues and identify practical solutions.

Excellent verbal and written communication skills with the ability to work professionally with internal and external partners.

Ability to manage multiple priorities in a fast-paced environment while maintaining accuracy, follow-through, and attention to detail.

Ability to work independently, use sound judgment, and collaborate across teams to resolve shipment barriers.

Preferred qualifications

Associate or bachelor's degree.

Experience in specialty pharmacy, advanced therapy, patient access, or shipment clearance operations.

Experience resolving claim rejections, coverage issues, reimbursement barriers, or payer-related shipment delays.

Experience working with healthcare providers, payer organizations, manufacturer contacts, pharmacy operations, or cross-functional business partners.

Knowledge of Express Scripts, Evernorth, or related pharmacy systems, products, and services.

Experience supporting process improvement, training, workflow enhancements, or operational projects.

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, paid holidays, and leaves of absence. 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.