In this pivotal role, CSRs respond primarily to phone, also fax and online inquiries from health care professionals to assist them through the medication prior authorization process. Initial screening of requests based on guidance given by online prior authorization tools. Approves prior authorization requests if the data collected meets the approval specifications. Refers prior authorization… … Read more
This position, the Nurse Case Manager Senior Analyst, through the case management process, will promote the improvement of health outcomes to members and assist those members experiencing the burdens of illness and injury. The Case Manager will assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual’s health needs within case … Read more
Position Summary: Responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources. Medical necessity reviews may include: planned elective services, surgical and diagnostic procedures, durable medical equipment and out of network services. Conduct reviews in compliance with medical policy, member eligibility, benefits, … Read more
We know your type. You are driven to make an impact on the business and internally motivated to improve how things are done. You are a quick learner, detail oriented, and can handle multiple priorities at once. You always keep your goals in mind and have a pretty easy-peasy time working with all different types … Read more
Job Description As an Eligibility Representative, Patient Access, Accredo , you’ll be part of a dedicatedteam thathelps our specialty pharmacy patients coordinate their medication needs and pharmacy insurance coverage for complex medical conditions such as HIV, rheumatoid arthritis, and cancer. This role is on the front lines with patients anddoctors’offices, responding to phone inquiries and… … Read more
As a Customer Service Representative at Cigna, you will play a pivotal role in delivering exceptional service to our clients, contributing to our mission of enhancing health and well-being. This is a remote position, offering flexibility and the opportunity to join a dynamic team dedicated to making a positive impact. Key Responsibilities: • Customer Support: … Read more
Position Summary: Responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources. Medical necessity reviews may include: planned elective services, surgical and diagnostic procedures, durable medical equipment and out of network services. Conduct reviews in compliance with medical policy, member eligibility, benefits, … Read more
Join our dedicated Customer Service and Claims teams at The Cigna Group, and our divisions, Cigna Healthcare and Evernorth Health Services. Here you can make a lasting impact in the lives of our 178 million customers worldwide. Evernorth Health Services employees listen with care and empathy to answer customers’ questions related to pharmacy and benefits … Read more
Cigna is a global health service company dedicated to improving the health, well-being, and peace of mind of those we serve. With a mission to help individuals lead healthier lives, Cigna offers a wide range of insurance and health services designed to meet the needs of customers worldwide. Job Title: Customer Service Representative (Cigna Remote … Read more
Job Requirements include, but not limited to: This position will be Mon-Fri 8 hour shifts with every other weekend (Tuesday ALT Day). • Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C • Ability to differentiate different types of requests Appeals, Grievances, coverage determination and Organization Determinations in order … Read more