CVS Health · 1 week ago
Eligibility Consultant
United States
Full-time
Remote
Entry Level
$17/hr - $25.65/hr
1+ years expCVS Health is the nation’s leading health solutions company, dedicated to transforming health care. The Eligibility Consultant will support multiple health plans by verifying enrollment status, maintaining databases, and resolving eligibility-related issues for clients.
Health CareMedicalPharmaceuticalRetailSales
Responsibilities
Responds, researches, and resolves eligibility and/or billing related issues involving member specific information; Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes
Monitors daily status reports assessing output for developing trends potentially impacting service levels
Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters
Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization
Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports)
Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations
When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging
Interprets and translates client benefits and supporting account structure against internal systems/applications (i.e.,GEBAR, AAS, and CCI)
Determines and communicates standard service charges to internal/external customers related to paper eligibility activities; May include negotiating and communicating charges pertaining to non-standard services
Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients
Qualification
Required
1 Year experience in Customer Service, Member Service, medical assistant, or similar role
High School Diploma or equivalent GED
Preferred
Knowledge of Health Care and/or MCO's
Knowledge of Enrollment
Knowledge Medicaid and/or Medicare
Knowledge and comfortability with learning different systems and using Excel (VLOOKUP)
Attention to detail and accuracy
Problem solving skills
Strong organization skills
Understands the impact of work to other teams and downstream support areas
Ability to analyze and research data to make appropriate corrections as necessary
Strong verbal and written communication skills
Workplace flexibility - ability to adapt to change
Benefits
Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access
Company
CVS Health
CVS Health is a health solutions company that provides an integrated healthcare services to its members.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$4BKey Investors
Michigan Economic Development CorporationStarboard Value
2025-08-15Post Ipo Debt· $4B
2025-07-17Grant· $1.5M
2019-11-25Post Ipo Equity
Leadership Team
David Joyner
President and Chief Executive Officer, CVS Health
Chandra McMahon
SVP & CISO
Recent News
2026-01-25
Company data provided by crunchbase