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Analyst, Eligibility

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States , Austin

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Category:
Customer Service

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Contract Type:
Employment contract

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Salary:

43888.00 - 85068.00 USD / Year
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Job Description:

Establishes and maintains processes regarding billing and claims processing, insurance verification and authorization, revenue cycle management, compliance and documentation, as well as customer service and issue resolution. Reconciles and solves issues to ensure accurate billing, facilitate smooth revenue flow, maintain compliance, and provide satisfactory customer experiences.

Job Responsibility:

  • Reviews and analyzes applications, forms, and supporting documentation to verify individuals' eligibility for healthcare programs or insurance coverage
  • Applies eligibility rules and regulations when evaluating information submitted by customers in support of initial or continuing eligibility determination
  • Compiles and evaluates information, calculating eligibility factors, and ensuring consistent and fair eligibility determinations
  • Escalates eligibility issues and updates member records in the appropriate database(s) to ensure accurate data
  • Conducts basic quality audits of eligibility uploads to ensure data integrity is clean, accurate, and consistent with specifications
  • Communicates regulations, rules, and policies to clients and apprises them of their rights, responsibilities, and eligibility for participation
  • Educates customers on basic program services and eligibility requirements
  • Coaches more junior colleagues in intellectual property techniques, processes, and responsibilities to help optimize eligibility reviews
  • Assigns tasks, sets performance goals, conducts performance evaluations, and provides training and educational development opportunities to team members

Requirements:

  • 2+ years customer service or client-facing experience in a fast-paced environment
  • Basic awareness of problem solving and decision making skills
  • Microsoft Office working experience
  • High School Diploma or G.E.D.

Nice to have:

  • 3+ years in eligibility or other relevant background
  • Proficiency in processing accurate and timely Eligibility data
  • Experience in EDI (Electronic Data Interchange)
  • Understanding of the PBM industry
  • Experience in a healthcare client facing role
  • Experience in a fast-paced environment
  • Knowledge of ANSI X12 834 Data Documents
  • Familiarity with RxClaim and/or AS400
  • Microsoft Excel experience
  • Bachelor's degree
What we offer:
  • Medical coverage
  • Dental coverage
  • Vision coverage
  • Paid time off
  • Retirement savings options
  • Wellness programs

Additional Information:

Job Posted:
May 17, 2026

Expiration:
July 04, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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