Senior Eligibility Consultant jobs in United States
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CVS Health · 19 hours ago

Senior Eligibility Consultant

CVS Health is committed to building a world of health around every individual, fostering a connected and compassionate health experience. The Senior Eligibility Consultant will process policy and eligibility data, collaborate with business partners, and deliver consulting services to resolve enrollment-related issues while mentoring junior team members.

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

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.

Company

CVS Health

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CVS Health is a health solutions company that provides an integrated healthcare services to its members.

Funding

Current Stage
Public Company
Total Funding
$4B
Key Investors
Michigan Economic Development CorporationStarboard Value
2025-08-15Post Ipo Debt· $4B
2025-07-17Grant· $1.5M
2019-11-25Post Ipo Equity

Leadership Team

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David Joyner
President and Chief Executive Officer, CVS Health
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Chandra McMahon
SVP & CISO
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Company data provided by crunchbase