Job Description

** Selected candidate must be located within driving distance of the Orlando , Florida office: 6272 Lee Vista Blvd., Orlando, FL 32822**Selected candidate must be available to work at home and flex to rotate IN THE OFFICE 3 times per month with a start time of 9am to 6pm EST Monday thru Friday.POSITION SUMMARYThe Customer Service Senior Representative performs specialized patient access functions requiring an advanced understanding of insurance benefits and internal processes in order to successfully liaise with Payers, Pharma, Physicians and Patients. This role directly interfaces with external clients and requires a high level of independent judgment in order to establish and maintain effective relationships with clients to gain their trust and support. Relies on experience and knowledge of industry best practices to identify exposures to the company and facilitates leadershipxe2x80x99s knowledge of pending referrals that may have an adverse impact on company goals and the patient experience. Acts as a liaison between both internal and external resources to reduce client abrasion, facilitate the timely processing of referrals and provide accurate status reporting to clients.ESSENTIAL FUNCTIONSFacilitates cross-functional resolution of drug coverage issues & proactively address, researches & resolves issues impacting revenue optimization.Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.Contacts benefit providers to gather policy benefits/limitations; coordinating and ensuring services provided will be reimbursable (e.g., deductible amounts, co-payments, effective date, levels of care, authorization, etc.). Directly interfaces with external clients.Performs medical /pharmacy benefit verification requiring complex decision skills based on payer and process knowledge resulting in on boarding or no starting a specialty patients.Provide expert assistance to clients on patient status. Liaison for company providing referral status reporting.May negotiate pricing for non-contracted payers and authorize patient services and ensure proper pricing is indicated in RxHome. Handle Escalations. Use discretion & independent judgement in handling pt or more complex client complaints, escalating as appropriate.QUALIFICATIONSHigh school diploma or GED required; bachelorxe2x80x99s degree preferred.3+ years of relevant working experience; Health care experience with medical insurance knowledge and terminology and experience in patient access preferred.Intermediate data entry skills and working knowledge of Microsoft Office, Patient Access knowledge.KNOWLEDGE AND ABILITIESExperience training and coaching less experienced staff with patience to explain details and processes repeatedly.Excellent phone presentation and communication skills.Demonstrated ability to handle challenging customers in a professional manner.Ability to adapt in a dynamic work environment and make decisions with minimal supervision.Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions.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 The Cigna GroupDoing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, wexe2x80x99re 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: 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.

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