Cigna Work From Home Jobs – Eligibility Representative

Website Cigna

Job Description:

Delivers straightforward administrative and/or other basic business services in Eligibility. Implements and maintains eligibility for benefits. Implements, updates, and maintains automated, direct connect and/or manual eligibility data. Interacts with internal partners and/or external clients/vendors. Generates reports to identify and resolve discrepancies. Identifies process improvement opportunities for own cases. May negotiate and resolve eligibility with clients. May provide technical support for the electronic processing of eligibility. Ensures customer data is installed accurately and timely. May work with client’s format and internal Systems to resolve errors. May interact with Systems to resolve technical issues. General knowledge of manual and automated eligibility. Familiar with reporting tools. Technical understanding of systems. Issues tend to be routine in nature. Good knowledge and understanding of Eligibility and business/operating processes and procedures. Works to clearly defined procedures under close supervision.

Job Responsibilities:

  • Independently resolves basic patient claims issues using key subject matter knowledge
  • Contacts benefit providers to gather policy benefits/limitations.
  • Coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.).
  • Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge
  • Effectively collaborates with internal departments to resolve issues or provide any needed information using professional communication at all times.
  • Provide expert assistance to internal and external clients on patient status.
  • Prepares and reviews claims to ensure accuracy to payer requirements, including but not limited to codes, dates and authorizations.
  • Facilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting referral turn-around time.
  • Demonstrates a technical proficiency

Job Requirements:

  • Intermediate data entry skills and working knowledge of Microsoft Office, Patient Access knowledge.
  • Extensive knowledge of ESI products and services a must.
  • Advanced problem solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions.
  • Health care experience with medical insurance knowledge and terminology and experience in patient access preferred.
  • Excellent phone presentation and communication skills.
  • Demonstrated ability to handle challenging customers in a professional manner.
  • Ability to adapt in a dynamic work environment and make decisions with minimal supervision.

Qualification & Experience:

  • High school diploma or GED required, bachelor’s degree preferred.
  • 3-5 years of relevant working experience.
  • Experience training and coaching less experienced staff with patience to explain details and processes repeatedly.

Job Details:

Company: Cigna

Vacancy Type: Full Time

Job Functions: Other

Job Location: Memphis, TN, US

Application Deadline: N/A

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