Senior Eligibility Representative- Accredo- Encore

Eligibility Senior Representative –Accredo-

Encore Program-This position is open to retirees of The Cigna Group

Make an Impact Where It Matters Most

As an Eligibility Senior Representative, you play a critical role at the intersection of patients, providers, payers, and specialty pharmacy operations. You bring clarity to complex insurance benefits, remove barriers to care, and help ensure patients receive timely access to life-changing therapies. With your experience and judgment, you proactively solve problems, reduce friction, and elevate the patient and client experience. This role is ideal for someone who is confident, compassionate, and energized by making a meaningful difference every day.

Key Responsibilities and Strategic Contributions

Drive timely referral processing by proactively identifying and resolving drug coverage and eligibility issues that impact turnaround time and patient access.

Serve as a trusted liaison between internal teams and external partners, including payers, providers, and pharmaceutical manufacturers, to reduce client abrasion and improve outcomes.

Independently resolve complex patient claims and eligibility issues using advanced knowledge of medical and pharmacy benefits.

Ensure claims and referrals meet payer requirements by accurately validating codes, dates, authorizations, and coverage criteria.

Perform complex medical and pharmacy benefit verifications, applying payer-specific rules and sound judgment to support reimbursable services.

Communicate patient status clearly and confidently to internal and external stakeholders, providing expert guidance and next steps.

Handle escalations with professionalism and discretion, applying deep understanding of policies while knowing when to escalate appropriately.

Identify trends and root causes that affect patient access and operational performance, and contribute to continuous improvement efforts.

Support team capability by coaching and guiding less experienced colleagues with patience and clarity.

Adapt quickly in a dynamic environment, balancing priorities while maintaining accuracy, empathy, and accountability.

Qualifications

Required Qualifications

High school diploma or GED.

Minimum of 3 years of relevant professional experience, including at least 2 years in healthcare with hands-on experience in medical or pharmacy insurance benefits.

Demonstrated experience in patient access, eligibility, benefits verification, or claims resolution.

Strong working knowledge of healthcare insurance terminology, processes, and payer requirements.

Proficiency with data entry and Microsoft Office tools.

Excellent verbal communication skills, including confidence handling complex or challenging conversations.

Proven ability to work independently, make sound decisions, and manage escalations with minimal supervision.

Advanced problem-solving skills and the ability to collaborate across departments to deliver solutions.

Preferred Qualifications

Bachelor’s degree.

Experience supporting specialty pharmacy or complex therapies.

Strong knowledge of Express Scripts, Inc. (ESI) products and services.

Experience training, mentoring, or coaching peers in processes and best practices.

Demonstrated ability to identify process gaps and contribute to operational improvements.

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.

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.

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.

If you require reasonable accommodation in completing the online application process, please email: SeeYourself@cigna.com for support. Do not email SeeYourself@cigna.com 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.