Eligibility Representative - Accredo - Remote

As an Eligibility Representative, you will play a critical role in helping patients gain access to life-saving medications by verifying insurance benefits, navigating coverage requirements, and providing exceptional support throughout the patient journey. This position combines customer service, problem-solving, and healthcare knowledge to ensure seamless experience for patients, providers, and internal partners.

Training & Schedule

• Training: Approximately 8-12 weeks (classroom and on-the-job training), Monday through Friday, 8:00 AM - 5:00 PM CST.
• Permanent Schedule: Assigned after training based on business needs and team assignment. Candidates must have open availability Monday through Friday between 7:00 AM and 7:00 PM CST.

Key Responsibilities

• Handle approximately 10-15 inbound calls daily from patients and providers regarding claims, account inquiries, insurance coverage, and medication shipment coordination.
• Complete an average of 25-35 outbound calls daily to insurance carriers, providers, patients, and internal partners.
• Research and resolve patient claims and coverage issues using established processes and subject matter expertise.
• Contact insurance providers to verify eligibility, benefits, coverage limitations, deductibles, copays, authorizations, and levels of care.
• Perform detailed medical and pharmacy benefit investigations while applying payer-specific requirements and guidelines.
• Coordinate with cross-functional teams to proactively address and resolve issues impacting referral turnaround times.
• Collaborate with internal departments to gather and provide information needed to support patient access to therapy.
• Ensure services provided are reimbursable and accurately documented in accordance with payer requirements.

Qualifications

• RxHome experience preferred
• Previous experience in healthcare, medical insurance, patient access, eligibility verification, benefits investigation, or preferred related field.
• Strong understanding of healthcare and medical insurance terminology.
• Excellent verbal and written communication skills with a professional phone presence.
• Ability to manage difficult conversations with professionalism, empathy, and confidence.
• Strong attention to detail, organizational skills, and ability to multitask in a fast-paced environment.
• Proficiency with computer applications and data entry.

Requirements

• High school diploma or equivalent required.
• Must have reliable high-speed internet through a wired connection (hotspots and mobile internet are not permitted).
• Must maintain a private, distraction-free workspace while working remotely.
• Ability to attend and successfully complete all required training during the first 90 days of employment.

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.

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.