Job Description Summary

Does your DREAM JOB involve WORKING FROM HOME and HELPING OTHERS? Join CIGNA! We want to change health care to make it more affordable, personalized, and focused on helping the whole person.

In this pivotal role, Customer Service Representatives respond to phone inquiries from health care professionals and assist them with the medication prior authorization process, by delivering straight forward administrative and/or other basic business services in Pharmacy Operations

A successful candidate will be able to interact effectively and efficiently with health care professionals using excellent interpersonal and listening skills, critical thinking, and problem-solving skills. The ability to multitask and use computer-based resources effectively is essential.

Confidently able to educate and provide accurate responses to inquiries is crucial for success. As a Prior Authorization Representative, you will be part of a dedicated team which provides information regarding pharmacy benefits and drug coverage. This crucial role is on the front lines with healthcare professionals, responding and addressing each phone inquiry with care, detail, and most importantly, empathy.

Primary Responsibilities

• Collection of structured clinical data for prior authorization and non-formulary exception requests following the guidance provided in our online prior authorization tools and corresponding forms.

• 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 requests that do not meet the approval specifications to a clinician for review.

• Independently responds to contacts ranging from routine to moderate complexity. May seek assistance with health care professionals for service issues of substantial complexity.

• Performs research to respond to inquiries and interprets policy provisions to determine the most effective response using established departmental procedures, HIPAA regulations, and corporate policies

Qualifications

• High School Diploma / GED

• 1+ years of call center experience

• Prior work from home experience

• Prior medical or pharmacy knowledge

• Reliable high-speed broadband internet, hard-wired connection.

  10 Mbps for download / 5 MBPS for upload

• Quiet and private space designated for work without interruption.

• Excellent Customer Service

• Excellent interpersonal communication, attention to detail, and critical thinking skills are essential.

• Excellent computer skills, with familiarity of Microsoft office and have a working knowledge of Windows operating system.

• Tech savvy, with the ability to easily navigate across multiple screens and applications.

• Must work any schedule between 8:00am – 9:00pm Eastern time, Monday through Friday. Permanent shifts will be chosen at the time of the job offer.

• Training Schedule is 9:00 am – 5:30 pm Easter time, Monday through Friday for 4 weeks and an additional 2 weeks for on-the-job training.

• Able to attain 100% attendance throughout the six weeks of training/on the job training and maintain excellent attendance beyond.

• Flexibility to support extended hours and overtime as determined by business needs to meet customer expectations.

Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status.