Healthcare Medicare Eligibility 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 Apply Job!