Join the CVS Health Team as an Eligibility Consultant and Make a Difference in Healthcare
CVS Health is a leading healthcare company that is dedicated to delivering enhanced human-centric healthcare for a rapidly changing world. We are seeking a highly skilled and compassionate Eligibility Consultant to join our team. As an Eligibility Consultant, you will play a critical role in verifying enrollment status, making changes to member/client records, and addressing a variety of enrollment questions or concerns. If you have a passion for delivering exceptional customer service and a strong background in healthcare, we encourage you to apply for this exciting opportunity.
About CVS Health
At CVS Health, we share a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric healthcare 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, and 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 healthcare more personal, convenient, and affordable.
Key Responsibilities
- Verify Enrollment Status: Under general supervision, verify enrollment status, make changes to member/client records, and address a variety of enrollment questions or concerns.
- Maintain Enrollment Databases: Maintain enrollment databases and coordinate electronic transfer of eligibility data.
- Respond to Eligibility Inquiries: Respond, research, and resolve eligibility and other enrollment-related issues involving member-specific information; work directly with clients, field marketing offices, and/or local claim operations to achieve positive service outcomes.
- Apply Technical Requirements: Apply all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure, and benefit parameters in addressing eligibility matters.
- Develop Tools and Resources: Develop tools, and provide coding supplements, tape specifications, and error listing to clients/vendors.
- Liaise with Clients and Vendors: Act as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identify potential solutions and approve programming specifications required for testing any non-standard arrangements.
- Ensure Data Integrity: 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 Team Functions: Partner with other team functions to coordinate the release of eligibility, plan structure, and benefit information.
- Complete Policy and Eligibility Screens: Complete required set-up of policy and eligibility screens in order to activate system processing of plan benefits.
- Code System Screens: Code system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products (i.e., ID cards).
- Ensure Legislative Compliance: Ensure that legislation and compliance have been properly adhered to with regard to Plan Sponsor and/or member activity.
- Utilize Online Resources: Utilize and interpret online resources to understand customer's account structure and benefits.
- Communicate with Clients: Determine and communicate standard service charges to internal/external customers related to electronic eligibility activities; may negotiate and communicate charges pertaining to non-standard services.
- Maintain HIPAA Compliance: Ensure all communications with clients, third-party administrators, and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.
Requirements and Qualifications
Essential Qualifications:
- Customer Service Experience: 1-2 years of customer service experience in a healthcare setting.
- Microsoft Office Proficiency: Proficient in Microsoft Office applications.
- Data Entry Experience: 1-2 years of experience doing data entry.
- Education: High school diploma or GED.
Preferred Qualifications:
- Eligibility Verification: Experience with eligibility verification.
- Medicaid or Medicare Experience: Medicaid or Medicare experience.
- Remote Work Experience: Experience with working at home.
What We Offer
Compensation and Benefits:
We offer a competitive salary and a comprehensive benefits package, including:
- Competitive Salary: The typical pay range for this role is $17.00 - $28.46 per hour.
- Medical, Dental, and Vision Benefits: A full range of medical, dental, and vision benefits.
- 401(k) Retirement Savings Plan: Eligible employees may enroll in the Company's 401(k) retirement savings plan.
- Employee Stock Purchase Plan: An Employee Stock Purchase Plan is also available for eligible employees.
- Term Life Insurance: A fully-paid term life insurance plan to eligible employees.
- Short-term and Long-term Disability Benefits: Short-term and long-term disability benefits.
- Well-being Programs: Numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.
- Paid Time Off: Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year.
Why Join CVS Health?
At CVS Health, we are committed to delivering exceptional customer service and making a positive impact on the lives of our customers. As an Eligibility Consultant, you will have the opportunity to:
- Make a Difference: Make a difference in the lives of our customers by delivering exceptional customer service and support.
- Grow and Develop: Grow and develop your skills and career in a dynamic and supportive environment.
- Work with a Purpose: Work with a purpose-driven company that is dedicated to delivering enhanced human-centric healthcare for a rapidly changing world.
How to Apply
If you are a motivated and compassionate individual who is passionate about delivering exceptional customer service, we encourage you to apply for this exciting opportunity. Please submit your application without delay.
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The application window for this opening will close on: 01/14/2025
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.
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