Senior Eligibility Consultant

About the role

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary This role is a senior individual contributor on the Eligibility team, responsible for accurate, timely eligibility processing and resolution of complex enrollment and eligibility issues. Senior Eligibility Consultants operate with increasing independence, manage a high volume of work across shifting priorities, and partner with internal teams, clients, and vendors to drive clear, high-quality outcomes. You’ll also support team capability by mentoring newer colleagues and helping bridge formal training into day-to-day production work.

Responsibilities

• Process policy and eligibility data accurately and on time using administration systems to support claim payment and plan sponsor service expectations
• Resolve complex eligibility and enrollment issues by investigating discrepancies, identifying root causes, and driving issues to closure
• Partner with internal teams, clients, and vendors to coordinate information, remove blockers, and achieve positive outcomes
• Anticipate potential issues and take action early to prevent rework, delays, or downstream impacts
• Contribute to process improvements that strengthen accuracy, efficiency, and consistency across workflows
• Support reporting and data discrepancy work by helping evaluate options, documenting trade-offs, and recommending workable paths forward
• Design and deliver transition support for newly hired colleagues as they move from classroom learning into the production environment
• Coach and mentor junior team members through side-by-side support, feedback, and knowledge sharing
• Manage multiple tasks and shifting priorities while maintaining quality and attention to detail
• Contribute as a strong team player who can operate independently when needed

Requirements

• 2+ years experience industry knowledge and enrollment/eligibility processing experience
• Demonstrated comfort with professional email communication, including clear documentation, timely updates, and appropriate tone with internal and external partners
• Ability to manage multiple incoming workflows and shifting priorities while staying organized and responsive
• Experience supporting internal reporting requirements, including tracking work status, documenting outcomes, and meeting reporting deadlines
• Proven ability to meet required turnaround times while maintaining strong accuracy