Eligibility Consultant Job at CVS Health (East Lansing)

Job Description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Job Responsibility

Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns
Maintains enrollment databases and coordinates electronic transfer of eligibility data
Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information
works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes
Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters
Develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors
Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting
identifies potential solutions and approves programming specifications required for testing any non-standard arrangements
Ensures all transactions interface accordingly with downstream systems
tests and validates data files for new or existing clients using system tools and tracks results to avoid potential problems and better address on-going service issues
Partners with other team functions to coordinate the release of eligibility, plan structure and benefit information
Completes required set-up of policy and eligibility screens in order to activate system processing of plan benefits
Codes system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products (i.e., ID cards)
Ensures that legislation and compliance have been properly adhered to with regard to Plan Sponsor and/or member activity
Utilizes and interprets online resources to understand customer's account structure and benefits
May assist with the development of such resources
Determines and communicates standard service charges to internal/external customers related to electronic eligibility activities
may negotiate and communicate charges pertaining to non-standard services
Ensures all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements

Requirements

1+ years of excellent customer service skills with the ability to communicate effectively with both internal and external customers
1+ years of Data entry experience
Must be able to type at least 35WPM
Excellent verbal and written communication skills including articulation, spelling, grammar, proofreading, and telephone skills
Experience with Word and proficient in Excel
High School diploma or G.E.D.

Nice to have

Basic knowledge of Health Insurance industry
6 months of more experience with QuickBase

What we offer

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
bonus, commission or short-term incentive program

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Eligibility Consultant

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