Prior Authorization Representative (MDM) - Evernorth - Remote - Cigna in : Job Details

Prior Authorization Representative (MDM) - Evernorth - Remote (Finance)

Summary: Delivers straightforward administrative and/or other basic business services in Medical Operations. Processes requests and responses for prior authorizations. Communicates approval or denial of requests and is responsible for making outbound and receiving inbound phone calls. Receives, sorts, processes, and distributes incoming mail and electronic fax requests. May have direct interaction with physicians and pharmacies regarding requests. Facilitates resolution of medical coverage issues and address, research, and resolve issues while maintaining accurate and complete documentation. Issues tend to be routine in nature. Works to clearly defined procedures under close supervision.

• Answer inbound calls from members, providers, and pharmacies with questions about Medical Drug Management (MDM) benefits and mail-order pharmacies
• Handle an average of 50-70 calls daily
• Take calls back-to-back while toggling through several applications on multiple screens
• Attend 100% of trainings and the first 90 days of employment
• Resolve customer complaints through independent problem-solving skills and one-call resolution
• Understand and strive to meet or exceed call center metrics while providing excellent consistent customer service
• Enjoy a work-from-home lifestyle where you can virtually connect with coworkers and customers
• Completes special projects as assigned

• High School diploma or equivalent
• A dedicated workspace with no distractions is required
• Intermediate proficiency in Microsoft Outlook
• Strong organization skills, written, and verbal communication skills
• Ability to remain calm and helpful even when dealing with difficult situations
• Foster teamwork and partnership with cross-functional departments to resolve issues and improve customer experience
• Good knowledge and understanding of the Medical Prior Authorization and business/operating processes and procedures

If 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.

This position anticipates offering an hourly rate of 17.75 - 26 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is anticipated to be eligible to participate in an annual bonus plan.

We want you to be healthy, balanced, and feel secure. 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) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, visit Life at Cigna Group.

About The Cigna Group

Doing 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, pregnancy or related medical conditions including 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.

If you require reasonable accommodation in completing the online application process, please email: [email protected] for support. Do not email [email protected] for an update on your application or to provide your resume as you will not receive a response.

The 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.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.