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. 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.
Generally has one to five years of contact center/customer service experience.
Able to maintain 100% attendance throughout 4 weeks of training and excellent attendance beyond training.
Flexibility to support extended hours and overtime as determined by business needs in order to meet customer expectations.
Must have a quiet and private space designated for work
MS Excel
MS Word
Customer Service skills
Record Keeping Skills
Time management competent
Prioritizing skills
Problem Solving Skills
Flexibility/Adaptability
Detail Oriented and Organized
Multi-tasker
Verbal and Written Communication
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Cigna Corp. provides medical, dental, disability, life and accident insurance and related products and services to businesses, governmental and non-governmental organizations and individuals. It operates through following segments: Global Health Care; Global Supplemental Benefits; Group Disability and Life; Other Operations; and Corporate.
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