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