Senior Eligibility Representative

The Cigna Group

Eligibility Senior Representative clearing Accredo patient accounts for medication shipment. Resolving insurance, authorization, reimbursement, and payer barriers to support timely therapy.

Posted 8/5/2026full-timeRemote • Texas • 🇺🇸 United StatesSenior💰 $19 - $29 per hourWebsite

Core Competencies

Role fit

Core Competencies

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

Demonstrates expertise in patient access, insurance verification, and reimbursement processes, with a strong focus on resolving barriers to medication shipment. Proven ability to communicate effectively with stakeholders and support process improvements in a fast-paced healthcare environment.

Highest-signal resume keywords

Patient Access ManagementInsurance VerificationReimbursement ProcessesProblem-Solving SkillsCommunication Skills

ATS Keywords

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Applicant Tracking System Keywords

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

Hard Skills

Healthcare ExperienceSpecialty Pharmacy KnowledgeClaim ResolutionAuthorization RequirementsRevenue Cycle ManagementAnalytical SkillsAttention to DetailMulti-Priority Management

Soft Skills

CollaborationIndependent JudgmentVerbal CommunicationWritten Communication

Tools & Technologies

Express ScriptsEvernorthPharmacy Systems

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Payer RequirementsMedication ShipmentCoverage IssuesReimbursement BarriersHealthcare ProvidersCross-Functional Collaboration

About the role

Key responsibilities & impact

Review patient accounts, insurance requirements, authorization status, and coverage details to determine shipment readiness.
Identify and resolve barriers preventing medication shipment, including claim rejections, reimbursement issues, benefit concerns, and payer requirements.
Coordinate benefit review, claim resolution, authorization validation, and payer requirement review to clear patients for shipment.
Research coverage and reimbursement challenges and determine next steps, escalation needs, and resolution plans.
Partner with pharmacy operations, patient access teams, healthcare providers, payers, manufacturers, and internal stakeholders to support timely shipment outcomes.
Escalate high-risk shipment barriers that could cause therapy interruption, delayed treatment, patient dissatisfaction, or financial impact.
Communicate shipment status, issue resolution, and trends to business partners and external contacts.
Serve as a subject matter resource for complex shipment clearance questions, insurance requirements, and patient access barriers.
Support process improvements, training, best-practice sharing, and special projects that improve shipment clearance and patient access outcomes.

Requirements

What you’ll need

Must be able to work Monday–Friday, 11:00 AM–8:00 PM EST
High school diploma or GED
Minimum of 3 years of experience in healthcare, specialty pharmacy, patient access, insurance verification, reimbursement, revenue cycle management, or a related field
Knowledge of medical or pharmacy insurance benefits, authorization requirements, payer requirements, claims, and reimbursement processes
Strong problem-solving and analytical skills
Excellent verbal and written communication skills
Ability to manage multiple priorities in a fast-paced environment while maintaining accuracy, follow-through, and attention to detail
Ability to work independently, use sound judgment, and collaborate across teams
If working at home, internet service must be through cable broadband or fiber optic with at least 10 Mbps download/5 Mbps upload
Preferred: associate or bachelor's degree
Preferred experience in specialty pharmacy, advanced therapy, patient access, or shipment clearance operations
Preferred experience resolving claim rejections, coverage issues, reimbursement barriers, or payer-related shipment delays
Preferred experience working with healthcare providers, payer organizations, manufacturer contacts, pharmacy operations, or cross-functional business partners
Preferred knowledge of Express Scripts, Evernorth, or related pharmacy systems, products, and services
Preferred experience supporting process improvement, training, workflow enhancements, or operational projects

Benefits

Comp & perks

Annual bonus plan eligibility
Medical benefits
Vision benefits
Dental benefits
Well-being and behavioral health programs
401(k)
Company-paid life insurance
Tuition reimbursement
Minimum of 18 days of paid time off per year
Paid holidays
Leaves of absence