Eligibility, Consultant Electronic

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

In this role as an Eligibility Analyst, 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 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 non-standard 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 on-going service issues

– Partner with other team functions to coordinate the release of eligibility, plan structure and benefit information

– Complete required set-up of policy and eligibility screens 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

 

Required Qualifications

– 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

Other Jobs You May Be Interested In

– 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, GED, or equivalent experience

 

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