Eligibility Consultant
About the role
Under general supervision, the role involves verifying enrollment status, making changes to member/client records, and addressing a variety of enrollment questions or concerns. Responsibilities also include maintaining enrollment databases, coordinating electronic transfer of eligibility data, responding to and resolving eligibility and other enrollment-related issues, developing tools, providing coding supplements, tape specifications, and error listings to clients/vendors, acting as a liaison between clients, vendors, and the IT department, ensuring all transactions interface correctly with downstream systems, testing and validating data files for new or existing clients, coordinating the release of eligibility, plan structure, and benefit information, completing required setup of policy and eligibility screens to activate system processing of plan benefits, coding system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products, ensuring adherence to legislation and compliance regarding Plan Sponsor and/or member activity, utilizing and interpreting online resources to understand customer's account structure and benefits, assisting with the development of such resources, determining and communicating standard service charges to internal/external customers related to electronic eligibility activities, and ensuring all communications with clients, third-party administrators, and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.
Responsibilities
- Verifies enrollment status and makes changes to member/client records
- 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
- Develops tools, provides coding supplements, tape specifications, and error listings to clients/vendors
- Acts as the liaison between clients, vendors, and the IT department
- Sets up policy and eligibility screens to activate system processing of plan benefits
- Codes system screens, policy, and structure to support downstream processes
- Ensures all transactions interface correctly with downstream systems
- Tests and validates data files for new or existing clients
- Coordinates the release of eligibility, plan structure, and benefit information
- Completes required setup of policy and eligibility screens
- Ensures adherence to legislation and compliance regarding Plan Sponsor and/or member activity
- Utilizes and interprets online resources to understand customer's account structure and benefits
- Assists with the development of such resources
- Determines and communicates standard service charges to internal/external customers related to electronic eligibility activities
- Ensures all communications with clients, third-party administrators, and/or brokers involving sensitive member data adhere to HIPAA compliance requirements
Requirements
- 1+ years of excellent customer service skills with the ability to communicate effectively with both internal and external customers
- 1+ years of Data entry experience
- Must be able to type at least 35WPM
- Excellent verbal and written communication skills including articulation, spelling, grammar, proofreading, and telephone skills
- Experience with Word and proficient in Excel
Qualifications
- Basic knowledge of Health Insurance industry
- 6 months of more experience with QuickBase
- High School diploma or G.E.D.
Preferred Qualifications
- Basic knowledge of Health Insurance industry
- 6 months of more experience with QuickBase
- High School diploma or G.E.D.
Pay
The typical pay range for this role is $17.00 - $31.30. This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Benefits
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.