Customer Coverage Review Department Customer Service Representative at Cigna

CCRD Customer Service Representative – Work from Home


Virtual, US


Customer Service & Claims

Job Id


CCRD Customer Service Representative

Band 1 Job Description

  • Customer Service Representative
    • Do you enjoy helping Health Care Professionals? Do you thrive in a fast-paced, customer-focused environment? Then start your rewarding career as a part of our growing Coverage Review Department! Cigna is one of the largest and fastest growing health insurers in the world.
    • At Cigna, we invest in you. As a Customer Service Representative you are offered extensive, paid, hands-on training and a supportive post-training environment to pave your way to success. Cigna encourages career development and offers continuing educational resources internally and externally to help you in your career advancement.
  • Role Summary
    • In this pivotal role, CSRs respond primarily to phone, also 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 is a must.
    • Confidently able to educate and provide accurate responses to inquiries is crucial for success.
  • 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 issue 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 have competent computer skills, be familiar with Microsoft office and have a working knowledge of Windows operating system.
    • Excellent interpersonal communication, attention to detail, critical thinking skills are essential
    • Candidates must have a quiet and private space designated for work
    • Must be able to work any schedule given between 8:00am 9:00pm Eastern. Monday through Friday.
    • Flexibility to support extended hours and overtime as determined by business needs in order to meet customer expectations.
    • Able to maintain 100% attendance throughout 4 weeks of training and excellent attendance beyond training.
    • Generally has one to five years of call center customer service experience.
    • High School Diploma or GED Required.
    • Qualified applicants will be considered for employment without regard to race, color, religion, national origin, sex, sexual orientation, gender identity, disability, veteran status.
  • Position not applicable in Louisiana, Nebraska, and Rhode Island

For this position, we anticipate offering an hourly rate of $17 – $22, depending on relevant factors, including experience and geographic location.

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

Helping our customers achieve healthier, more secure lives is at the heart of what we do. While you take care of our customers, we’ll take care of you through a comprehensive benefits program that helps you be at your best. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and best in class well-being and behavioral health programs. We also offer 401(k) with company match, company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and dozens of corporate discounts on essentials you use every day.

About Cigna

Cigna Corporation exists to improve lives. We are a global health service company dedicated to improving the health, well-being and peace of mind of those we serve. Together, with colleagues around the world, we aspire to transform health services, making them more affordable and accessible to millions. Through our unmatched expertise, bold action, fresh ideas and an unwavering commitment to patient-centered care, we are a force of health services innovation. When you work with us, or one of our subsidiaries, you’ll enjoy meaningful career experiences that enrich people’s lives. What difference will you make?

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.

Cigna 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.