Senior Eligibility Consultant, CVS Health

CVS Health

Location:
United States

Category:
Customer Service

Contract Type:
Not provided

Salary:

18.50 - 42.35 USD / Hour

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Job Description:

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

Verify enrollment status, make changes to member/client records, and address a variety of enrollment questions or concerns
Maintain enrollment databases and coordinate electronic transfer of eligibility data
Respond, research, and resolve eligibility and other enrollment related issues involving member specific information
work directly with clients, vendors and/or local claim operations to achieve positive service outcomes
Apply all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters
Develop tools, and provide coding supplements, file specifications and error listing to clients/vendors
Act as the liaison between clients, vendors with defining business requirements
identify potential solutions and approve programming specifications required for testing
Ensure all transactions interface accordingly with downstream systems
test and validate data files for new or existing clients using system tools and track results to avoid potential problems and better address on-going service issues
Partner with other team functions to coordinate the release of eligibility, plan structure and benefit information
Utilize and interpret online resources to understand customer’s account structure and benefits
Ensure all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements

Requirements:

2+ years of experience in healthcare/insurance industry customer service with the ability to communicate effectively with both internal and external customers
2+ years of data entry experience
Proficiency with Microsoft Office products (e.g.
Word, Excel, PowerPoint, Outlook, Teams)

Nice to have:

Previous eligibility data experience
Demonstrated working experience with EDI Files
Working knowledge of 834 file layouts
Demonstrated ability to creatively solve problems and create improvements
Excellent verbal and written communication skills including articulation, spelling, grammar, proofreading and telephone skills
Ability to manage multiple tasks and shifting priorities
Ability to manage high work volume and oversee a variety of incoming work flows
A team player capable of operating independently and able to assist other team members
Ability to deliver accurate and timely results

What we offer:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility

Additional Information:

Job Posted:
April 24, 2025

Expiration:
May 05, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Senior Eligibility Consultant