Job Summary

Cigna, through its Evernorth Health Services division, is seeking a highly detail-oriented and proactive Authorization Specialist II to support utilization management and authorization processes across healthcare services. This role plays a critical part in ensuring timely, accurate, and compliant authorization of medical and behavioral health services in accordance with payer policies, clinical guidelines, and regulatory standards.

The Authorization Specialist II serves as a key liaison between providers, internal clinical teams, and health plans, ensuring members receive appropriate care while maintaining operational efficiency and compliance.

Key Responsibilities

• Review, process, and manage prior authorization requests for medical, behavioral health, and ancillary services.

• Evaluate requests against established clinical criteria, benefit plans, and medical policies.

• Communicate effectively with healthcare providers, members, and internal stakeholders to obtain required documentation and clarify authorization requirements.

• Coordinate with clinical reviewers, nurses, and medical directors for escalated or complex cases.

• Ensure accurate data entry and documentation within authorization and claims systems.

• Adhere to turnaround time (TAT) requirements and service-level agreements (SLAs).

• Identify discrepancies, trends, or process gaps and recommend improvements.

• Maintain compliance with HIPAA, CMS, NCQA, and other regulatory and accreditation standards.

• Support audits, quality reviews, and reporting initiatives as required.

• Assist in mentoring or supporting junior authorization staff when needed.

Required Skills and Qualifications

• Strong knowledge of healthcare authorization, utilization management, or claims processes.

• Excellent analytical and problem-solving abilities.

• High level of accuracy and attention to detail.

• Strong verbal and written communication skills.

• Ability to manage multiple priorities in a fast-paced environment.

• Proficiency in healthcare systems, electronic medical records (EMR), and authorization platforms.

• Customer-focused mindset with the ability to handle sensitive information professionally.

• Intermediate proficiency in Microsoft Office tools (Excel, Word, Outlook).

Experience

• Minimum 2–4 years of experience in healthcare administration, authorization processing, utilization management, or a related field.

• Prior experience working with health plans, managed care organizations, or provider offices preferred.

• Experience with medical necessity criteria (e.g., InterQual, MCG) is an advantage.

• Exposure to Evernorth, Cigna, or large payer environments is a plus.

Working Hours

• Full-time position, typically 40 hours per week.

• Standard business hours with flexibility based on operational needs.

• Remote or hybrid work options may be available depending on location and business requirements.

Knowledge, Skills, and Abilities

• Solid understanding of healthcare benefits, authorization workflows, and payer-provider relationships.

• Ability to interpret clinical documentation and policy guidelines accurately.

• Strong organizational and time-management skills.

• Ability to work independently while collaborating effectively within a team.

• Adaptability to changing regulations, policies, and business priorities.

• Commitment to confidentiality and ethical standards in healthcare operations.

Benefits

• Competitive salary and performance-based incentives.

• Comprehensive medical, dental, and vision insurance.

• Retirement savings plans with employer contributions.

• Paid time off, holidays, and wellness programs.

• Employee assistance programs (EAP).

• Career development, learning, and advancement opportunities.

• Inclusive and supportive work culture focused on employee well-being.

Why Join Cigna – Evernorth Health Services

At Cigna and Evernorth Health Services, employees are empowered to make a meaningful impact on healthcare delivery and patient outcomes. You will be part of a mission-driven organization that values innovation, collaboration, diversity, and professional growth. Joining Evernorth means contributing to smarter, more affordable, and more accessible healthcare for millions of people worldwide.

How to Apply

Interested candidates are encouraged to apply through the Cigna Careers Portal by submitting an updated resume and any relevant supporting documentation. Qualified applicants will be contacted by the recruitment team for further assessment and interview opportunities.