CVS Health · 16 hours ago
Eligibility Consultant (Phoenix, AZ)
Phoenix, AZ
Full-time
Onsite
Entry Level
$17/hr - $28.46/hr
2+ years expCVS Health is dedicated to building a connected and compassionate health experience. The Eligibility Consultant will respond to and resolve eligibility and enrollment-related issues, ensuring compliance with Medicare guidelines and processing updates across various systems.
Health CareMedicalPharmaceuticalRetailSales
Responsibilities
Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns
Maintains enrollment databases and coordinates electronic transfer of eligibility data
Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes
Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure, and benefit parameters in addressing eligibility matters
Develops tools, and provides coding supplements, tape specifications, and error listing to clients/vendors
Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements
Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools; and tracks results to avoid potential problems and better address ongoing service issues
Partners with other team functions to coordinate the release of eligibility, plan structure, and benefit information
Completes required set-up of policy and eligibility screens in order to activate system processing of plan benefits
Codes system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products (i.e., ID cards)
Ensures that legislation and compliance has been properly adhered to with regard to Plan Sponsor and/or member activity
Utilizes and interprets online resources to understand customer’s account structure and benefits
May assist with the development of such resources
Determines and communicates standard service charges to internal/external customers related to electronic eligibility activities; may negotiate and communicate charges pertaining to non-standard services
Ensures all communications with clients, third-party administrators, and/or brokers involving sensitive member data adhere to HIPAA compliance requirements
Qualification
Required
2-3 years of experience with eligibility verification
2-3 years of experience with data entry and customer service
Demonstrated proficiency with Microsoft Office Suite
Must reside within a commutable distance to Phoenix, AZ
High school diploma or GED
Preferred
Previous experience with Medicaid and/or Medicare
Previous work from home experience
Strong time management skills
Ability to operate independently
Excellent organization skills
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