Customer Service Representative - Remote - Orlando, Florida - The Cigna Group : Job Details

Remote position available for full-time work. Must be located within driving distance of the Orlando, Florida office and able to go into the office 2x/week - 1x/month. Must be able to work Monday - Friday, 9am - 6pm EST.

Essential Functions:

• Receive & manage 10-60 inbound patient calls per day, depending on time of year
• Facilitate cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization
• Perform medical/pharmacy benefits verification requiring complex decision skills based on payer and process knowledge resulting in onboarding or no starting specialty patients
• Contact benefit providers to gather policy benefits/limitations
• Coordinate and ensure the services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.)
• Directly interface with external clients
• Provide expert assistance to clients on patient status
• Liaison for the company providing referral status reporting
• May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome
• Handle escalations
• Use discretion & independent judgment in handling more complex client complaints, escalating as appropriate
• Complete other projects and additional duties as assigned

Qualifications:

• Must be located within driving distance of the Orlando, Florida office
• Must be able to go into the Orlando, Florida office anywhere from 2x/week - 1x/month
• Must be able to work Monday - Friday, 9am - 6pm EST
• HS Diploma or GED required
• 3+ years' relevant work experience
• Customer service experience required; Healthcare or Pharmacy experience with medical insurance knowledge and terminology and experience in patient access preferred
• Data entry skills and working knowledge of Microsoft Office
• Strong phone presentation and communication skills
• RxHome or Care Centrale experience a plus
• Demonstrated ability to handle professionally challenging customers
• Ability to adapt in a dynamic work environment and make decisions with minimal supervision
• Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions
• Strong attention to detail & critical thinking skills

About Evernorth Health Services:

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.