Senior Eligibility Representative

The Cigna Group

Eligibility Senior Representative performing specialized patient access functions and resolving drug coverage issues. Collaborating with Payers, Pharma, Physicians, and Patients to enhance patient experience.

Posted 7/29/2026full-timeRemote • Tennessee • 🇺🇸 United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in medical insurance knowledge and terminology, with a strong focus on patient access and claims resolution. Proficient in problem-solving and collaboration across departments to enhance operational efficiency.

Highest-signal resume keywords

Medical Insurance KnowledgePatient Access ExperiencePrior Authorization ExperienceAdvanced Problem-Solving SkillsIntermediate Data Entry Skills

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims PreparationClaims ReviewPayer RequirementsBenefits VerificationData Entry

Soft Skills

Professional CommunicationCustomer HandlingAdaptabilityCollaboration

Tools & Technologies

Microsoft Office

Industry Keywords

Health CareReferral Turn-Around TimePatient Claims IssuesBenefit ProvidersDynamic Work Environment

About the role

Key responsibilities & impact

Facilitate cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time.
Independently resolve basic patient claims issues using key subject matter knowledge.
Prepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates, and authorizations.
Effectively collaborate with internal departments to resolve issues or provide any needed information, always using professional communication.
Contact benefit providers to gather policy benefits/limitations.
Perform medical /pharmacy benefits verification requiring complex decision skills based on payer and process knowledge.
Complete other projects and additional duties as assigned.

Requirements

What you’ll need

High school diploma or GED required, bachelor’s degree preferred
At least 2+ years of related working experience.
Must have Health care experience with medical insurance knowledge and terminology and experience in patient access.
Intermediate data entry skills and working knowledge of Microsoft Office.
Excellent phone presentation and communication skills.
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.
Prior Authorization experience

Benefits

Comp & perks

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.