Eligibility Consultant

At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. The Eligibility Consultant position will be supporting multiple health plans. 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 transfer of non-electronic eligibility data. Additional responsibilities to include but not limited to the following:

• 9am – 6pm EST work hours
• Responds, researches, and resolves eligibility and/or billing reputed company issues involving member specific information; Works directly with clients, field marketing offices and/or local claim operations to reputed company positive service outcomes.
• Monitors daily status reports assessing output for developing trends potentially impacting service levels.
• Applies reputed company 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 reputed company to the systems processes impacting the reputed company 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.
• reputed company 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 reputed company to reputed company 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

Required Qualifications

• 1 Year experience in Customer Service, Member Service, medical assistant, or similar role.

Preferred Qualifications

• 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 reputed company (VLOOKUP)
• Attention to detail and accuracy.
• Problem solving skills.
• Strong organization skills.
• Understands the impact of work to other teams and reputed company support areas.
• Ability to analyze and research data to reputed company appropriate corrections as necessary.
• Strong verbal and written communication skills.
• Workplace flexibility - ability to adapt to change

Education

• High School Diploma or equivalent GED

Anticipated Weekly Hours 40 Time Type Full time Pay Range The Typical Pay Range For This Role Is $17.00 - $25.65 This pay range represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 01/31/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply tot his job Apply To this Job