- Responsible for determining plan eligibility and enrolling members within CMS regulatory guidance
- Work to save members with incorrect/incomplete applications by performing customer, physician and/or agent outreach and using support tools. Maintain member demographic update and membership revalidation and apply eligibility requirements for membership changes
- Research and respond to eligibility inquiries as needed
- Ensure all enrollment eligibility is reconciled and maintained in accordance with CMS and departmental guidelines, requirements, regulations, policies, and procedures
- This position involves reviewing incoming applications, keying information into systems, determining eligibility, and saving submissions as needed
- Phone calls to potential customers and Medicaid systems will be made as needed throughout the day. In addition to phone calls, Medicaid websites will be reviewed to gather additional information and eligibility verification on enrollees
- High school diploma or GED required
- 1+ years of experience with Medicare and state Medicaid highly preferred
- 1+ years of experience with Medicare Advantage - Part C, highly preferred
- Prior data entry and enrollment experience, highly preferred
- 1+ years of experience with prior; enrollment, reconciliation, and/or eligibility strongly preferred
- Proficient with Microsoft Office suite products, required
- Critical thinking and strong attention to detail, required
- Excellent verbal and written communication skills - communications should be respectful, professional, proactive and polite at all times, required
- Must be able to act quickly and proactively in a rapidly changing and dynamic work environment, required
- Strong Customer Service skills, required
- Strong organizational skills and ability to manage multiple tasks simultaneously in a fast-paced, customer-oriented environment, required
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Eligibility Senior Representative - Remote, United States - The Cigna Group
Description
Do you want to improve the health and vitality of those we serve? The Cigna Group is hiring an Eligibility Senior Representative to review incoming applications, keying information into systems, determining eligibility, and saving submissions as needed. You'll also manage some phone inquiries to potential customers and Medicaid systems as needed throughout the day. In addition to phone calls, websites will be reviewed to gather additional information on enrollees.
How you'll make a difference:
What you'll need to succeed:
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 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. 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: for support. Do not email 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.
