Eligibility Representative, Specialty - Evernorth- Remote

Insurance Verification Coordinator, Specialty (Eligibility Representative) – Evernorth – Remote

As an Insurance Verification Coordinator, you will help patients access the care they need by ensuring accurate insurance verification, clear communication of benefits, and timely completion of reimbursement requirements. You will play a key role in creating a smooth, supportive experience for patients and providers.

• Verify patient insurance coverage, calculate estimated costs, and document details clearly in the patient profile.

• Enter and update accurate patient demographics in the system.

• Generate coverage and financial responsibility quotes and review benefits with patients by phone.

• Track, monitor, and secure required insurance and reimbursement documents.

• Obtain prior authorizations and coordinate financial assistance forms, payment agreements, and waivers.

• Support onboarding by helping train new employees.

• Organize and prioritize daily tasks to meet productivity and quality standards.

• Create new hospital and physician codes as needed.

• Partner with internal teams to ensure smooth reimbursement workflows and excellent client service.

• Research reimbursement issues and contribute to continuous improvement efforts.

• High school diploma or GED.

• 1+ year of insurance verification, prior authorization, or related experience in a healthcare setting.

• Knowledge of medical terminology.

• Proficient computer skills, including Microsoft Office.

• Strong math, communication, and organizational skills.

• Experience with payer websites and coordination of benefits.

• Knowledge of pharmacy vs. medical payers and authorization processes.

• Familiarity with plan formularies and authorization requirements.

As part of Evernorth Health Services, this role supports CarepathRx within our Pharmacy and Care Delivery organization. Our team focuses on specialty pharmacy and infusion services in partnership with hospitals and health systems.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, 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), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

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.