{"id":4204926,"url":"https://alion.io/job/the-cigna-group-eligibility-representative-remote","title":"Eligibility Representative - Remote","company":{"id":13928,"name":"The Cigna Group","domain":"thecignagroup.com","url":"https://alion.io/company/thecignagroup","size_band":"5000+","is_staffing_agency":false,"employer_type":"direct","is_intermediary":false,"listed_via":null,"ats_vendor":"Workday","truth_index":{"grade":"A","score":88,"open_postings":83,"ghost_share":0.048,"stale_share":0.494,"repost_share":0.12,"time_to_fill_p50_days":20,"computed_at":"2026-11-12T10:38:37Z"}},"role":"Healthcare","role_family":"Healthcare","seniority":"junior","employment_type":"full_time","work_mode":"remote","remote_scope":"stated_countries","remote_scope_basis":"board_field","remote_working_hours":{"label":"EST","utc_offset_min":-5,"utc_offset_max":-5},"hiring_geo_confidence":"structured","locations":["United States"],"countries":["US"],"hiring_countries":["US"],"hiring_countries_total":1,"salary":{"min":17,"max":26,"currency":"USD","period":"hour","gross":null,"usd_annual":52000},"salary_estimate":null,"experience_years_min":1,"visa_sponsorship":false,"relocation_package":false,"has_equity":false,"technologies":[{"name":"Microsoft Office","optional":false},{"name":"SharePoint","optional":false}],"status":"live","first_seen_at":"2026-11-12T23:22:04Z","employer_posted_date":"2026-11-12","last_verified_at":"2026-11-12T23:22:04Z","board_verified":true,"closed_at":null,"days_open":0,"trust":{"level":"ok","repost_count":null,"flags":[],"days_open":0},"description":"As an Eligibility Representative at Accredo, you will be part of a team passionate about helping our patients with billing and ensuring their access to life saving medications. This role helps our specialty pharmacy patients coordinate their medication needs and pharmacy insurance coverage for complex medical conditions such as HIV, rheumatoid arthritis and cancer. This role is on the front lines with patients and doctors offices, responding to phone inquiries and addressing each with care, detail, and most importantly, empathy.\nWhat you’ll do:\nDeliver straightforward administrative and/or other basic business services in Eligibility\nImplement and maintain eligibility for benefits\nImplement, update, and maintain automated, direct connect and/or manual eligibility data\nInteract with internal partners and/or external clients/vendors\nGenerate reports to identify and resolve discrepancies\nIdentify process improvement opportunities for own cases\nNegotiate and resolve eligibility with clients\nFacilitate cross-functional resolution of drug coverage issues & proactively address, research & resolve issues impacting referral turn-around time\nIndependently resolve basic patient claims issues using key subject matter knowledge\nPrepare and review claims to ensure accuracy to payer requirements, including but not limited to codes, dates and authorizations\nEffectively collaborate with internal departments to resolve issues or provide any needed information\nContact benefit providers to gather policy benefits/limitations\nCoordinate and ensure services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.)\nPerform medical/pharmacy benefit verification requiring complex decision skills based on payer and process knowledge\nProvide technical support for the electronic processing of eligibility\nEnsure customer data is installed accurately and timely\nWork with client's format and internal systems to resolve errors\nInteract with systems to resolve technical issues\nWhat you’ll need to do the job:\nMust be able to work an 8 hour shift within the hours of 7am - 6pm EST (Mon - Fri)\nHigh school diploma or GED required\n1+ years of relevant working experience - customer service, billing, healthcare, pharmacy, insurance industry preferred\nExperience with healthcare, medical insurance terminology and patient access preferred\nGeneral knowledge & understanding of manual and automated eligibility\nGeneral PC knowledge including experience working with Microsoft Office, Excel, Teams, SharePoint, PowerPoint\nFamiliar with reporting tools and/or RX Home, Copay Assistance, or CSP experience a plus\nStrong data entry skills and computer skills\nExcellent phone presentation and communication skills\nDemonstrated ability to handle difficult conversations in a professional manner\nAbility to adapt in a dynamic work environment and make decisions independently\nAdvanced problem solving skills and the ability to work collaboratively with other departments\nWorks to clearly defined procedures under close supervision\nIf 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.For this position, we anticipate offering an hourly rate of 17.75 - 26 USD / hourly, depending on relevant factors, including experience and geographic location.\nThis role is also anticipated to be eligible to participate in an annual bonus plan.\nAt The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.\nAbout The Cigna Group\nDoing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.\nIf you need a reasonable accommodation to complete the online application process, please email  for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.\nThe Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.\nQualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.","description_format":"text","description_chars":5950,"description_truncated":false,"requirements":{"experience_years_min":1,"management_years_min":null,"team_size_min":null,"manages_managers":false,"education":{"level":"high_school","optional":false},"security_clearance":false,"languages":[]},"benefits":["Health insurance","Insurance coverage","Life insurance"],"hiring_locations":[{"name":"United States","iso":"US","kind":"country"}],"hiring_excludes":[],"relocation_offered":false,"industries":["Pharmacies","Health Insurance & Benefits"],"lifecycle":[{"event":"open","at":"2026-11-12T23:22:04Z"}],"visa":[{"country":"US","licensed_sponsor":false,"adverts_offering_sponsorship_24m":6,"sanctioned_now":false,"evidence":"Offered visa sponsorship in 6 of its adverts here in 24 months","filings_12m":0,"filings_prev_12m":0,"green_card_filings_12m":0,"median_offered_wage_usd":null,"route":null,"cap_exempt":false,"checked_at":"2026-11-12T07:36:15+00:00","sources":["Alion: sponsorship offered in the employer's own job adverts (24 months)"],"filings_for_role_12m":0}],"liveness":{"score":86,"band":"hot","label":"Hiring now","p_open":1,"p_active":0.86,"p_room":1,"age_days":0,"expected_fill_days":20,"reasons":["conf:1","win:early","comp:junior,brand"],"computed_at":"2026-11-13T00:23:17Z"},"pay":{"stated_usd_annual":52000,"is_top_pay":false},"html_url":"https://alion.io/job/the-cigna-group-eligibility-representative-remote","json_url":"https://alion.io/job/the-cigna-group-eligibility-representative-remote.json","meta":{"generated_at":"2026-11-13T00:23:17Z","cache_seconds":300,"methodology":"https://alion.io/methodology","terms":"https://alion.io/terms","contact":"https://alion.io/contact","api":"https://alion.io/developers","about":"Alion is a live layer of people, companies and AI agents: who they are, whether they are real and active right now, what they do and how to work with them, readable by people and by agents and paid per call.","catalog":"https://alion.io/catalog.json","usage":{"tier":"crawler_verified","counted_by":"address","units_charged":1,"used_today":929,"day_limit":null,"remaining_today":null,"minute_limit":300,"resets_at":"2026-11-14T00:00:00Z"}},"offers":[{"id":"company.slices","title":"One company in depth, by slice","status":"live","price":{"credits":0.1,"usd":0.01,"plus_per_slice":{"credits":0.05,"usd":0.005}},"unit":"per company, plus each slice with data","note":"the employer in depth","call":{"mcp_tool":"get_company","arguments":{"id":13928},"rest":"https://alion.io/mcp/rest/get_company?id=13928"},"human":"https://alion.io/catalog?offer=company.slices&for=job%2Fthe-cigna-group-eligibility-representative-remote"},{"id":"market.stats","title":"A market slice: pay, demand and time to fill","status":"free","price":{"credits":0,"usd":0},"unit":"per slice","note":"pay, demand and time to fill for this role and place","call":{"mcp_tool":"market_stats"},"human":"https://alion.io/catalog?offer=market.stats&for=job%2Fthe-cigna-group-eligibility-representative-remote"},{"id":"job.search","title":"Open jobs by role, technology, place, pay and visa","status":"live","price":{"credits":0.1,"usd":0.01},"unit":"per posting in a list","note":"similar open postings","call":{"mcp_tool":"search_jobs"},"human":"https://alion.io/catalog?offer=job.search&for=job%2Fthe-cigna-group-eligibility-representative-remote"},{"id":"company.verify","title":"Is this company real and active right now","status":"pilot","price":null,"unit":"per company","request":{"url":"https://alion.io/catalog/request","method":"POST","body":"{\"offer\": \"company.verify\", \"for\": \"job/the-cigna-group-eligibility-representative-remote\", \"note\": \"what you need it for\"}"},"human":"https://alion.io/catalog?offer=company.verify&for=job%2Fthe-cigna-group-eligibility-representative-remote"}],"agent":{"mcp":"https://alion.io/mcp/jobs","mcp_open":"https://alion.io/mcp/open","next":[{"tool":"get_job","arguments":{"id":4204926}},{"tool":"search_jobs","arguments":{"company":"thecignagroup.com","detail":"compact"}},{"tool":"match_people","arguments":{"job_id":4204926},"note":"people open to offers who fit this vacancy"}],"note":"The same data through MCP tools: https://alion.io/mcp/open needs no sign-in (compact searches, postings, people); https://alion.io/mcp with an Alion account has everything. Docs: https://alion.io/developers"}}