The Cigna Group

Customer Service Representative

The Cigna Group

full-time

Posted on:

Origin:  • 🇺🇸 United States • Florida

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Job Level

Mid-LevelSenior

About the role

  • Receive & manage 10-60 inbound patient calls per day, depending on time of year
  • Facilitate cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting revenue optimization
  • Perform medical/pharmacy benefits verification requiring complex decision skills based on payer and process knowledge resulting in onboarding or no starting specialty patients
  • Contact benefit providers to gather policy benefits/limitations
  • Coordinate and ensure the services provided will be reimbursable (deductible amounts, co-payments, effective date, levels of care, authorization, etc.)
  • Directly interface with external clients and provide expert assistance to clients on patient status
  • Serve as liaison for referral status reporting
  • May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome
  • Handle escalations using discretion & independent judgment and escalate as appropriate
  • Complete other projects and additional duties as assigned

Requirements

  • Must be located within driving distance of the Orlando, Florida office: 6272 Lee Vista Blvd., Orlando, FL 32822
  • Must be able to go into the Orlando, Florida office anywhere from 2x/week - 1x/month
  • Must be able to work Monday - Friday, 9am - 6pm EST
  • HS Diploma or GED required
  • 3+ years' relevant work experience
  • Customer service experience required
  • Healthcare or Pharmacy experience with medical insurance knowledge and terminology and experience in patient access preferred
  • Data entry skills and working knowledge of Microsoft Office
  • Strong phone presentation and communication skills
  • RxHome or Care Centrale experience a plus
  • Demonstrated ability to handle professionally challenging customers
  • Ability to adapt in a dynamic work environment and make decisions with minimal supervision
  • Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions
  • Strong attention to detail & critical thinking skills
  • If working at home, internet via cable broadband or fiber with at least 10Mbps download/5Mbps upload required