Eligibility Senior Representative - Accredo - Remote

Join the Advanced Therapy New Referrals team and help patients access complex therapies with confidence. In this role, you will review benefits, resolve coverage questions, and work with patients, providers, payers, and internal partners to move referrals forward. You will use critical thinking, accuracy, and clear communication to support a smooth experience and help patients understand their coverage and financial options.

Responsibilities

• Conduct medical and pharmacy benefit investigations to confirm eligibility, coverage, payer requirements, and patient financial responsibility.
• Verify insurance eligibility, benefit details, coverage limitations, and documentation requirements to support timely referral processing.
• Identify prior authorization, appeal, step therapy, quantity limit, and other utilization management requirements that may affect access to therapy.
• Research and resolve complex reimbursement, eligibility, and coverage issues by working with payers, providers, patients, and internal partners.
• Educate patients on copay, coinsurance, and financial responsibility, and assist with enrollment in available copay assistance, manufacturer support programs, and patient assistance programs, as applicable.
• Document referral activity accurately in company systems and follow departmental procedures to support service, quality, and compliance expectations.
• Monitor assigned referrals, manage escalations, and help reduce delays in therapy initiation and treatment continuity.

Required qualifications

• High school diploma or equivalent.
• Minimum of 1 year of experience in healthcare, specialty pharmacy, patient access, reimbursement, insurance verification, or a related field.
• Knowledge of insurance eligibility, coverage requirements, reimbursement processes, prior authorization, or payer requirements.
• Strong attention to detail, problem-solving skills, and ability to manage multiple priorities while maintaining accuracy.
• Clear verbal and written communication skills with the ability to explain coverage and financial information in a professional way.
• Ability to use computer systems and accurately document work.

Preferred qualifications

• Experience conducting medical and pharmacy benefit investigations.
• Experience supporting specialty pharmacy, patient access, reimbursement, or new referral intake workflows.
• Experience working with complex medical and pharmacy benefit structures or payer requirements.
• Knowledge of specialty drug reimbursement, copay assistance, manufacturer support programs, or patient assistance programs.

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.