[Remote] Eligibility Consultant

Note: The job is a remote job and is open to candidates in USA. CVS 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.

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

Skills

• 1 Year experience in Customer Service, Member Service, medical assistant, or similar role
• High School Diploma or equivalent GED
• 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 Overview