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CVS Health · 1 month ago

Senior Eligibility Consultant

East Lansing, MI

Full-time

Hybrid

Mid, Senior Level

$18.50/hr - $38.82/hr

2+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care for millions of Americans. As a Senior Eligibility Consultant, you will process policy and eligibility data, collaborate with business partners, and mentor junior team members to ensure services meet plan sponsor needs.

Health CareMedicalPharmaceuticalRetailSales

Responsibilities

Process accurate and timely policy and eligibility data utilizing administration systems for claim payment purposes and product production ensuring services and products meet plan sponsor needs

Collaborate with business partners to understand enterprise initiatives and goals

Respond to eligibility and other enrollment related issues

Partner directly with clients, vendors, internal teams, and/or local claim operation to resolve problems and achieve positive outcomes

Anticipate and prevent problems and roadblocks before they occur

Solve complex problems and take a new perspective on existing solutions

Design, develop, and deliver transitional training processes and procedures to smooth the transition for newly hired employees from formalized classroom training to the department’s production environment; mentor junior team members

Assist with and/or evaluate recommendations involving eligibility reporting solutions and negotiate with internal/external clients

Deliver consulting services in support of data discrepancies and/or involving reporting alternatives

Qualification

Eligibility consultingPolicy data processingIndustry knowledgeEnrollment processingCoachingTask managementMentoringProblem-solvingTeam collaboration

Required

2+ years experience as an Eligibility Consultant

Proficiency in processing accurate and timely policy and eligibility data, ensuring services and products meet the plan sponsor needs

Understands intent/end state and operates with minimal guidance to meet that intent/end state

Ability to manage multiple tasks and shifting priorities

A team player capable of operating independently when needed

Provides accurate and timely results

Delegates and follows up as needed

Coaches and mentors others

Ability to manage high work volume and oversee a variety of incoming work flows

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

Preferred

Industry knowledge

Enrollment processing experience

Benefits

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.