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Eligibility Lead Representative

3 months ago

Remote, Oregon, United States The Cigna Group Full time
The job profile for this position is Eligibility Lead Representative, which is a Band 2 Professional Career Track Role.

Excited to grow your career?

We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position you see is right for you, we encourage you to apply

Our people make all the difference in our success.

***Must be able to work a shift between 7am to 8pm CST, Monday-Friday***

Want to Drive Growth and Improve Lives? Accredo, a specialty pharmacy line of business within The Cigna Group, is hiring several Eligibility Lead Representatives. For this demanding role, you'll ensure our patients receive prescription insurance coverage for their very specialized medication. You'll manage back-to-back; inbound and outbound calls collaborating with insurance providers, doctors' offices and patients gathering information to ultimately obtain insurance coverage. Your persistence and continuous follow up will ensure our patients to receive this vital medication in a timely manner.

How you'll make a difference:

  • Use your knowledge of the healthcare industry, Prescription Benefit Programs, pharmacy coverage, Reimbursement and Insurance processes to ensure patients get their specialty medication.
  • Manage constant inbound and outbound calls exemplifying the highest customer service standards to meet quality and production metrics
  • Use your advanced technical skills to navigate through multiple systems, applications and screens simultaneously all while speaking on the phone.
  • Use your independent judgement in managing escalated patient or client complaints and discretion to escalate further if needed

What you'll need to be a success:

  • High school diploma or GED, required
  • 1+ years of customer service experience, required
  • 2+ years of experience with Prescription Benefit Programs, Pharmacy Coverage, Prior Authorization, Eligibility or Insurance processes, preferred
  • 2+ years of experience in healthcare, medical terminology, CPT and ICD codes Preferred
  • Proficiency with Microsoft Office products (Word, Outlook, Excel) required
  • Pharmacy Technician experience or license, preferred

REQUIREMENT: This position requires that the applicant successfully complete registration with the Missouri State Board of Pharmacy as a pharmacy technician. This process includes a criminal background check, fingerprinting, and a review of the last three years of state income tax filings. Additional information about these requirements can be found at


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 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.

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.

Please note that you must meet our posting guidelines to be eligible for consideration. Policy can be reviewed at this link.