Eligibility Representative - Payer Solutions

GENERAL PURPOSE:

Incumbent will be a member of the Payer Solutions Operations eligibility team; the primary responsibility is eligibility maintenance.

RESPONSIBILITIES:


* Responsible for eligibility maintenance of Payer Solutions member data in Genasys
+ Timely Payer notification of errors
+ Clarifies member data as necessary
+ Supports Payer with manual updates when applicable
+ Works with matrix partners to correct data disjoints in downstream


* Responsible for membership reporting


* Supports eligibility inquiries from internal staff and clients (phone, email, meetings, Webex)


* Responsible for IF reversals, which includes validation that requests contain proper approval and tracking each reversal


* Responsible reporting production- weekly reports and monthly production reports


* Performance Guarantee tracking, as required.


* Understanding of data flow and process for correcting data disjoints


* Project SME


* Other duties as assigned

SKILLS/Knowledge


* 3-4 years of customer service and claim experience.

Eligibility experience preferred.


* Strong written and verbal skills


* Genasys AS/400 experience preferred


* OneNote, HTM, ODS, IBoR/Impersonator experience preferred


* Demonstrated organizational, analytical and problem-solving ability


* Ability to prioritize work and manage multiple projects with competing deadlines


* Intermediate Skills in Word, Excel, Access and OneNote


* Ability to pass a keyboarding test which includes 10 Key skills

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.

For this position, we anticipate offering an hourly rate of 17.75 - 25 USD / hourly, depending on relevant factors, including experience and geographic location.

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

We want you to be healthy, balanced, and feel secure.

That's why 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.

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