at The Cigna Group in Springfield, Illinois, United States
Job Description
As an Eligibility Senior Representative, you will coordinate medical and pharmacy coverage to determine payer status.
This is a great opportunity for someone who wants to expand their career and widen their skillset in coordination of benefits including medical and pharmacy.
How you’ll make a difference in this role:
+ Process 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 and/or 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.
+ Implement, update, and maintain automated, direct connect and/or manual eligibility data
+ Receive files from CMS – Verify Insurance coverage (Active or Termed)
+ Handle National Accounts or more complex accounts
+ Reconcile accounts for non-standard requests
+ Provide technical support for the electronic procession of eligibility
+ Ensures customer data is installed accurately and timely
+ Analyze formats that are customized directly by the client Analyze claims requests related to inquiries of other coverage
+ Work directly with Systems to design formats
+ Provide recommendations to decrease errors
+ Use your thorough technical knowledge of manual and automated eligibility to act as a resource to others
Qualification:
+ High School Diploma or GED required, advanced degree preferred
+ 1+ years of experience verifying benefit eligibility (medical and/or pharmacy)
+ 3+ years Healthcare Insurance Background preferred
+ Experience or knowledge in Medicare Part C (Medical) and Part D (Pharmacy)
+ Strong analytical skills
+ Excellent Communication Skills Written and Verbal
+ Strong customer service focus
+ Ability to handle heavy Outbound & Inbound Calls
+ Experience or knowledge of 3rd Party Liability (Deals with Auto Accidents)
+ Skilled in using Microsoft Window Programs (specifically: Excel and Word)
+ Experience with SQL preferred
This position is remote, work from home, and is expected to primarily have a schedule within normal business hours, Monday – Friday, or as business needs dictate.
If you will be working at home occasionally or permane
