Eligibility Senior Representative - Accredo

Accountabilities:
The Eligibility Senior Representative is responsible for supporting patients and healthcare offices through accurate eligibility reviews, benefit explanations, and issue resolution. The role requires strong customer service skills, empathy, and the ability to manage multiple priorities while ensuring a smooth access process. Manage inbound calls from patients and healthcare providers regarding insurance coverage, patient access, reimbursement support, and referral updates. Review and validate patient demographics, insurance details, and referral information to ensure accurate processing. Explain healthcare benefits, including copays, coinsurance, deductibles, coverage limitations, and financial responsibilities. Educate patients on available financial support options, including assistance programs and affordability resources. Identify and help resolve access barriers related to insurance requirements, authorizations, coverage concerns, or financial challenges. Provide clear updates regarding referral progress, required actions, and next steps to support timely treatment access. Address escalated patient and provider concerns professionally while applying sound judgment and problem-solving skills. Maintain quality, productivity, and service standards while creating a positive experience for every interaction. Requirements: The ideal candidate brings experience in customer service, healthcare support, insurance verification, or related fields, with the ability to communicate clearly and work effectively in a fast-paced environment. High school diploma or equivalent required. Minimum of 1 year of experience in a phone queue, call center, healthcare, specialty pharmacy, patient access, reimbursement support, insurance verification, customer service, or similar environment. Ability to work a Monday through Friday schedule between 9:00 AM and 6:30 PM EST. Strong verbal communication, active listening, and customer service skills. Excellent problem-solving abilities with strong attention to accuracy and detail. Ability to manage multiple tasks and priorities while maintaining a high level of service. Comfortable working in a changing environment where patient needs and operational priorities may evolve. Preferred experience with medical or pharmacy benefit investigations, specialty pharmacy services, reimbursement support, or patient access programs. Familiarity with specialty medication reimbursement, copay assistance programs, insurance benefits, and financial support resources is a plus. Reliable home internet connection through cable broadband or fiber optic service with minimum speeds of 10Mbps download and 5Mbps upload is required for remote work. Benefits: Competitive hourly compensation ranging from $19 to $29 USD per hour, depending on experience and location. Eligibility to participate in an annual bonus program. Comprehensive medical, dental, and vision coverage. Well-being and behavioral health support programs. 401(k) retirement plan. Company-paid life insurance. Tuition reimbursement opportunities. Minimum of 18 days of paid time off annually, plus paid holidays and leave programs. Remote work flexibility with support for home-based employees.

How Jobgether works:
We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.
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