Eligibility Consultant-Electronic
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.
Position Summary
In this role, as an Eligibility Consultant, you will:
• 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.
Required Qualifications
• 1+ years of experience in healthcare/insurance industry customer service with the ability to communicate effectively with both internal and external customers.
• 1+ years of data entry experience.
• Experience with Microsoft Office products (e.g.; Word, Excel, PowerPoint, Outlook, Teams)
Preferred Qualifications
• Ability to review and understand various file layouts.
• Strong verbal and written communication skills.
• Comfortable with leading calls with various participant types.
• Knowledge of ELR file processes.
• Experience with EDI files.
Education
• High school diploma or GED.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The Typical Pay Range For This Role Is
$17.00 - $34.15
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great Benefits For Great People
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
• 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.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 05/05/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Apply Now
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.
Position Summary
In this role, as an Eligibility Consultant, you will:
• 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.
Required Qualifications
• 1+ years of experience in healthcare/insurance industry customer service with the ability to communicate effectively with both internal and external customers.
• 1+ years of data entry experience.
• Experience with Microsoft Office products (e.g.; Word, Excel, PowerPoint, Outlook, Teams)
Preferred Qualifications
• Ability to review and understand various file layouts.
• Strong verbal and written communication skills.
• Comfortable with leading calls with various participant types.
• Knowledge of ELR file processes.
• Experience with EDI files.
Education
• High school diploma or GED.
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The Typical Pay Range For This Role Is
$17.00 - $34.15
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great Benefits For Great People
We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
• 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.
For more information, visit https://jobs.cvshealth.com/us/en/benefits
We anticipate the application window for this opening will close on: 05/05/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Apply Now