Healthcare Customer Service Representatives

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 – 5:00pm EST (prefers candidates who live in EST & CST)

Quick notes/highlights:

• Familiarity of/ having a basic knowledge of Medicare will be helpful for these candidates.
• Customer service experience that has exposure to insurance or Medicare will be helpful.
• They will be trained in a few parts of the team and deployed as needed to support different branches of the team
• Need to have basic computer skills. These candidates need to know how to navigate different screens and programs.
• Need to have basic Microsoft Office/Excel skills and experience
• High volume work. When they log-in, they will be assigned a queue of what they need to work on
• They will receive Q-Net and Medicare training, will learn how to process the records they receive in their queues
• 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

• Facilitates accurate processing of Enrolment applications to ensure timely input and acceptance to CMS.
• Performs account benefit verification requiring complex decision skills based on payer and process knowledge resulting in proper access to care.
• Process Reconciliation files from CMS to include Disenrollments, Late Enrollment Penalties and Low Income Subsidies
• 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
• Process Coordination of Benefits and Medicare Secondary Payer files from CMS to meet Federal and State Regulatory guidelines.
• Ensure accuracy of data entry to allow for meeting proper Service Level Agreements
• Use discretion & independent judgement in handling more complex cases and be willing to learn new skills within the Enrollment Functions
• Directly interfaces with other teams within Cigna
• Provide support to other internal functions as needed.
• May need to be proficient in Multiple Systems
• Completes other projects and additional duties as assigned.

Skills

• Knowledge of CMS Enrolment & Reconciliation process
• Knowledge of CMS Billing requirements and regulations
• Knowledge in Coordination of Benefits and Medicare Secondary Payer
• Medicare Part C and Part D
• 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.
• Excellent presentation and communication skills.
• Demonstrated ability to handle challenging interactions 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
• SQL (a plus not required)

Education

• High school diploma or GED required; bachelor’s degree preferred.
• 3+ years of relevant working experience.