Eligibility Consultant

Job Description

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
 
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.

Position Summary

• 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 has been properly adhered to with regard to Plan Sponsor and/or member activity.
• Utilizes and interprets on line 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.

Required Qualifications

• Excellent customer service skills with the ability to communicate effectively with both internal and external customers.
• Excellent verbal and written communication skills including articulation, spelling, grammar, proofreading, and telephone skills.
• Experience with Word and Excel.
• Data entry experience.
• High school diploma or GED.

Preferred Qualifications

Education

• High School diploma, G.E.D. or equivalent experience

Pay Range
The typical pay range for this role is: $17.00 – $28.45.

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.

In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.

For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 03/27/2024

CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. 

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health can provide a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through ColleagueRelations@CVSHealth.com If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.