Customer Service Representative Jobs

Role Summary

In this pivotal role, Customer Review Representatives respond to phone, fax, and online inquiries from health care professionals to assist them through the medication prior authorization process.

The successful candidate will be able to interact appropriately and efficiently with health care professionals using excellent interpersonal and listening skills, critical thinking, and problem solving skills. The ability to use computer-based resources in a highly effective manner to educate and provide accurate responses to inquiries is crucial for success.

This role is Work from Home which allows most work to be performed at home or on occasion at a Cigna office location. Employees must be fully vaccinated if they choose to come onsite.

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/or 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 Pharmacist for clinical review.

Independently responds to contacts ranging from routine to moderate complexity. May seek assistance with health care professional services issues of substantial complexity.

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

Qualifications

Must be able to work any schedule given between 9:00AM and 9:00PM Eastern Time0 Monday through Friday.

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

Able to maintain excellent attendance throughout 5 weeks of training and beyond.

High School Diploma or GED Required.

Generally has one to five years of contact center/customer service experience.

Must be a current contractor with Cigna, Express Scripts, or Evernorth. Evernorth is a new business within the Cigna Corporation.

This position is not eligible to be performed in Colorado.