Eligibility Representative

The Cigna Group

Eligibility Representative at Evernorth Health Services coordinating medication needs and insurance coverage for patients. Handling inquiries with empathy and accuracy in a remote setting.

Posted 8/2/2026full-timeRemote • Alabama, South Carolina, Tennessee • 🇺🇸 United StatesJuniorWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in insurance eligibility verification, prior authorization processes, and benefits investigation within healthcare settings. Proficient in documenting insurance information accurately while maintaining high attention to detail and effective communication with payer representatives.

Highest-signal resume keywords

Eligibility VerificationPrior Authorization ProcessesInsurance DocumentationCommunication SkillsHealthcare Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Benefits InvestigationInsurance Eligibility ReviewPayer Criteria NavigationPharmacy Benefits KnowledgeMedical Benefits Interpretation

Soft Skills

Attention to DetailOrganizational SkillsProfessional Communication

Certifications & Qualifications

High School Diploma

Industry Keywords

HealthcareHealth InsuranceThird-Party PayersOutbound CommunicationCoverage Information

About the role

Key responsibilities & impact

Review and interpret insurance eligibility, coverage details, and benefit limitations to determine clearance requirements.
Initiate outbound communication with insurance plans and third‑party payers to obtain benefit details, resolve coverage questions, and confirm authorization requirements.
Navigate prior authorization processes by gathering required information and ensuring payer criteria are met accurately.
Document benefit findings, authorization outcomes, and clearance decisions thoroughly and consistently within internal systems.
Apply feedback and payer knowledge to continuously improve accuracy, efficiency, and overall clearance quality.

Requirements

What you’ll need

Minimum of 1 year of experience in a healthcare or health insurance setting performing eligibility verification, benefits investigation, prior authorizations, or patient access support.
Direct experience working with insurance plans or payers, including outbound calls to obtain or clarify coverage information.
Working knowledge of pharmacy (PBM) benefits and medical benefits, with the ability to interpret plan details accurately.
Experience documenting insurance and authorization information with a high level of accuracy and attention to detail.
Ability to manage detailed, repetitive work in a structured environment while maintaining consistency and quality.
Strong written and verbal communication skills appropriate for professional interactions with payer representatives.
High School Diploma or equivalent.

Benefits

Comp & perks

Must live and work remotely in one of the following states: Alabama, Indiana, South Carolina, or Tennessee.
Internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.