Job Description
Job Title: Eligibility Associate Representatives
Pay Rate: $16/Hour...
100% work at home
Start Date: 10/14/2024-End Date: 3/31/2025 (Higher possibility of an extension)
8:30am ย 5:00pm EST (prefers candidates who live in EST & CST)
Quick notes/highlights:
ย Familiarity of/ having a basic knowledge of Medicare will be helpful for these candidates.
ย Customer service experience that has exposure to insurance or Medicare will be helpful.
ย They will be trained in a few parts of the team and deployed as needed to support different branches of the team
ย Need to have basic computer skills. These candidates need to know how to navigate different screens and programs.
ย Need to have basic Microsoft Office/Excel skills and experience
ย High volume work. When they log-in, they will be assigned a queue of what they need to work on
ย They will receive Q-Net and Medicare training, will learn how to process the records they receive in their queues
ย Some candidates might have to be on the phone more than others depending on the team they are placed on.
Delivers specific delegated Eligibility tasks assigned by a supervisor. Implements, updates, and maintains automated, direct connect and/or manual eligibility data. May handle reconciliation for non-standard requests. May provide technical support for the electronic procession of eligibility. Ensures customer data is installed accurately and timely. Technical knowledge of manual and automated eligibility. Completes day-to-day Eligibility tasks without immediate supervision, but have ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues.
ESSENTIAL FUNCTIONS
ย Facilitates accurate processing of Enrolment applications to ensure timely input and acceptance to CMS.
ย Performs account benefit verification requiring complex decision skills based on payer and process knowledge resulting in proper access to care.
ย Process Reconciliation files from CMS to include Disenrollments, Late Enrollment Penalties and Low Income Subsidies
ย Timely and Accurate processing of monthly Premium payments including identification and processing of write offs, resolution of credit balances and posting of payments to member accounts
ย Process Coordination of Benefits and Medicare Secondary Payer files from CMS to meet Federal and State Regulatory guidelines.
ย Ensure accuracy of data entry to allow for meeting proper Service Level Agreements
ย Use discretion & independent judgement in handling more complex cases and be willing to learn new skills within the Enrollment Functions
ย Directly interfaces with other teams within Cigna
ย Provide support to other internal functions as needed.
ย May need to be proficient in Multiple Systems
ย Completes other projects and additional duties as assigned.
Skills
ย Knowledge of CMS Enrolment & Reconciliation process
ย Knowledge of CMS Billing requirements and regulations
ย Knowledge in Coordination of Benefits and Medicare Secondary Payer
ย Medicare Part C and Part D
ย Health care experience with medical insurance knowledge and terminology and experience in patient access preferred.
ย Intermediate data entry skills and working knowledge of Microsoft Office.
ย Excellent presentation and communication skills.
ย Demonstrated ability to handle challenging interactions in a professional manner.
ย Ability to adapt in a dynamic work environment and make decisions with minimal supervision.
ย Advanced problem-solving skills and the ability to work collaboratively with other departments to resolve issues with innovative solutions
ย SQL (a plus not required)
Education
ย High school diploma or GED required; bachelorยs degree preferred.
ย 3+ years of relevant working experience
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