Job Description

GENERAL PURPOSE:

Incumbent will be a member of the Payer Solutions Operations eligibility team; the primary responsibility is eligibility maintenance. Incumbents will be assigned a book of business and be responsible for supporting the needs of the client.

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 downstream data disjoints
• Attends client meetings
• Responsible for membership reporting
• Supports eligibility inquiries from internal staff and clients (phone, email, meetings, IM)
• Responsible for IF reversals, which includes validation that requests contain proper approval and tracking each reversal
• Responsible for 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
• Responsible for meeting all defined goals for production, quality and turnaround times

SKILLS/Knowledge

• 3-4 years of customer service and claim experience
• 2+ years of eligibility experience
• 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.

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.

Cigna