Senior Eligibility Representative

The Cigna Group

Eligibility Senior Representative reviewing benefits and resolving coverage issues for Evernorth Health Services’ specialty-pharmacy referrals. Supporting patients, providers, payers, and internal partners to improve therapy access and continuity.

Posted 8/16/2026full-timeRemote • Arizona, Pennsylvania, Texas • 🇺🇸 United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in insurance eligibility verification, reimbursement processes, and patient access management, with a strong focus on attention to detail and effective communication. Proficient in navigating complex medical and pharmacy benefit structures while ensuring compliance and quality in documentation.

Highest-signal resume keywords

Insurance Eligibility VerificationReimbursement ProcessesPatient Access ManagementPrior Authorization KnowledgeClear Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Medical Benefit InvestigationsPharmacy Benefit InvestigationsDocumentation AccuracyUtilization ManagementComplex Problem Solving

Soft Skills

Attention to DetailTime ManagementProfessional Communication

Tools & Technologies

Computer Systems

Industry Keywords

Specialty PharmacyPayer RequirementsCopay Assistance ProgramsPatient Assistance ProgramsInsurance Verification

About the role

Key responsibilities & impact

Conduct medical and pharmacy benefit investigations to confirm eligibility, coverage, payer requirements, and patient financial responsibility
Verify insurance eligibility, benefit details, coverage limitations, and documentation requirements for timely referral processing
Identify prior authorization, appeal, step therapy, quantity limit, and other utilization management requirements affecting therapy access
Research and resolve complex reimbursement, eligibility, and coverage issues with payers, providers, patients, and internal partners
Educate patients on copay, coinsurance, and financial responsibility
Assist with enrollment in available copay assistance, manufacturer support, and patient assistance programs
Document referral activity accurately in company systems and follow departmental procedures for service, quality, and compliance
Monitor assigned referrals, manage escalations, and help reduce delays in therapy initiation and treatment continuity

Requirements

What you’ll need

High school diploma or equivalent
Minimum of 1 year of experience in healthcare, specialty pharmacy, patient access, reimbursement, insurance verification, or a related field
Knowledge of insurance eligibility, coverage requirements, reimbursement processes, prior authorization, or payer requirements
Strong attention to detail and problem-solving skills
Ability to manage multiple priorities while maintaining accuracy
Clear verbal and written communication skills
Ability to explain coverage and financial information professionally
Ability to use computer systems and accurately document work
Experience conducting medical and pharmacy benefit investigations preferred
Experience supporting specialty pharmacy, patient access, reimbursement, or new referral intake workflows preferred
Experience with complex medical and pharmacy benefit structures or payer requirements preferred
Knowledge of specialty drug reimbursement, copay assistance, manufacturer support programs, or patient assistance programs preferred
For home work, cable broadband or fiber optic internet with at least 10Mbps download/5Mbps upload

Benefits

Comp & perks

Copay assistance, manufacturer support programs, and patient assistance programs, as applicable
Remote work arrangement
Tobacco-free policy
Reasonable accommodation support for the online application process