Prior Authorization Representative- Evernorth- Remote

If you are organized, patient focused, and ready to grow in healthcare, this role is a great place to start. As a Prior Authorization Representative, you will help patients get approval for Home Infusion and Enteral Nutrition services by working with insurance companies, care teams, and providers. You build strong communication skills, and support a team that is focused on timely, compassionate service.

Job Summary

The Prior Authorization Representative supports the authorization process for home infusion and enteral services. This includes submitting new and renewal requests, following up with insurance plans, helping collect medical documents, and sharing updates with patients, prescribers, and internal teams. This role is ideal for a candidate who enjoys details, teamwork, problem solving, and helping patients move through the care process with less delay.

Hours: 8:30am-5pm EST, Monday-Friday

Responsibilities

• Submit initial and renewal prior authorization requests through payer portals, phone, fax, or other approved methods.
• Track open requests and follow up on time to help reduce delays in care.
• Review information for accuracy and completeness before sending requests to insurance plans.
• Work with clinicians and internal teams to gather documents needed to support authorization requests.
• Share clear updates with patients, prescribers, and team members about approvals, denials, or next steps.
• Respond to email, chat, and other requests in a timely and professional way.
• Manage daily tasks and priorities while meeting team quality and productivity goals.
• Keep patient information private and document work accurately.

Qualifications

Required Qualifications

• High school diploma or GED.
• Minimum 1 year of experience in customer service, administrative support, healthcare support, insurance, call center, data entry, or a related role.
• Basic knowledge of medical terminology
• Comfort using computers and Microsoft Office applications, including Outlook, Word, and Excel.
• Clear written and verbal communication skills.
• Strong attention to detail and ability to stay organized while managing multiple tasks.
• Customer-focused mindset and ability to work well with patients, providers, and internal teams.
• Ability to handle confidential patient information with care.

Preferred Qualifications

• Experience in healthcare, insurance verification, prior authorization, patient access, billing, pharmacy, home infusion, or durable medical equipment (DME).
• Familiarity with payer websites, insurance eligibility, coordination of benefits, formularies, denials, or appeals.
• Experience working in a fast-paced team environment where accuracy and follow-up are important.

As part of Evernorth Health Services, this role supports CarepathRx within

our Pharmacy and Care Delivery organization. Our team focuses on specialty pharmacy and infusion services in partnership with hospitals and health systems.

If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

For this position, we anticipate offering an hourly rate of 17.75 - 26 USD / hourly, depending on relevant factors, including experience and geographic location.

This role is also anticipated to be eligible to participate in an annual bonus plan.

At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year, paid holidays, and leaves of absence. For more details on our employee benefits programs, click here.

About The Cigna Group

Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.

Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws.

If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes.

The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State.

Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.