Eligibility Consultant

4 days ago

Minneapolis, Minnesota, United States CVS Health Full time
Job Summary

At CVS Health, we're committed to delivering enhanced human-centric healthcare for a rapidly changing world. As an Eligibility Consultant, you'll play a vital role in transforming our culture and accelerating our ability to innovate and deliver solutions that make healthcare more personal, convenient, and affordable.

Key Responsibilities

• Verify enrollment status, make changes to member/client records, and address a variety of enrollment questions or concerns
• Maintain enrollment databases and coordinate transfer of eligibility data
• Utilize and interpret online resources to understand account structure and benefits, may assist with the development of such resources
• Respond, research, and resolve eligibility and other enrollment related issues involving member specific information by working directly with clients, vendors, and internal partners 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
• Act as the liaison between clients, vendors, and the IT department defining and identifying business requirements and solutions for nonstandard arrangements
• 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 ongoing service issues
• Partner with other team functions to coordinate the release of eligibility, plan structure and benefit information
• Complete required setup of policy and eligibility screens in order to activate system processing of plan benefits
• Code system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products
• Ensure all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements

Requirements

• Excellent written and verbal communication skills which demonstrate the ability to interact courteously and effectively with both internal and external customers; skills include listening and comprehension, constructive feedback, spelling, grammar, proofreading, and telephone communication
• Demonstrated ability to creatively solve problems and create improvements
• Experience with Word, Excel, Outlook
• Data entry experience
• Understands intent/end state and operates with minimal guidance to meet that intent/end state
• 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 when needed
• Deliver accurate and timely results
• Follows up as needed to effectively resolve an issue

Preferred Qualifications
Previous experience is a plus

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

Pay Range
The typical pay range for this role is: $31.30

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.

This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

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 Benefits | CVS Health

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