Immediately Require Eligibility Senior Representative - Remote - Evernorth in Bloomfield, CT

Job title: Eligibility Senior Representative - Remote - Evernorth
Company: Cigna
Job description: This is a Remote position. Hours of operation Monday - Friday from 8:30am-5:00pm EST.

In the Eligibility Senior Representative role, you will implement, update, and maintain automated, direct connect and/or manual eligibility data and responsibility for inbound and outbound calls. Performing insurance verification daily. Rendering exceptional customer service to customers. Daily tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members.

Role Responsibilities:

• Processing Medicare Secondary Payer (MSP), Coordination of Benefits (COB), Financial Information Reporting (FIR) and State Pharmaceutical Assistance Program (SPAP) in accordance with CMS, NAIC, COBRA, Federal and State Regulatory guidelines.
• Review, research and determine the appropriate benefit coverage for MSP and COB verifications, SPAP enrollments/ terminations, FIR rejections and ensure data is fully reconciled and maintained in Plan systems in accordance with CMS, HIPPA, Internal Audit, Company/Departmental guidelines, policies, and procedures.
• Will handle National Accounts or more complex accounts.
• Reconciles accounts for non-standard requests.
• Will 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.
• Will work directly with Systems to design formats. Provides recommendations to decrease errors.
• Acts as a resource to others on non-routine work.
• Thorough technical knowledge of manual and automated eligibility.
• Receive files from CMS - Verify Insurance is Active.
• 3rd Party Liability - Deals with Auto Accidents.

Requirements:

• 3+ years of Healthcare Insurance background required.
• Experience with Medicare C (Medical) and Part D (Pharmacy) required.
• High School Diploma or GED required; Associate's degree preferred.
• Experience with Microsoft Windows Programs(specifically: Excel and Word) required.
• High volume customer service inbound/outbound experience a plus.
• Strong analytical skills.
• Excellent communication skills, verbal and written.
• Experience with SQL a plus.

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 17 - 25 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 The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we're dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. 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: [email protected] for support. Do not email [email protected] 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.
Expected salary:
Location: Bloomfield, CT

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