Eligibility Consultant - Electronic

At CVS Health, 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 reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

In this role as an Eligibility Analyst, you will:

• Verify enrollment status, make changes to member/client records, and address a variety of enrollment questions or concerns

• Maintain enrollment databases and coordinate transfer of eligibility data

• Utilize and interpret online resources to understand account structure and benefits, may assist with the development of such resources

• Respond, research, and resolve eligibility and other enrollment related issues involving member specific information by working directly with clients, vendors, and internal partners to achieve positive service outcomes

• Apply all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters

• Act as the liaison between clients, vendors, and the IT department defining and identifying business requirements and solutions for non-standard arrangements

• 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 other team functions to coordinate the release of eligibility, plan structure and benefit information

• Complete required set-up of policy and eligibility screens in order to activate system processing of plan benefits

• Code system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products

• Ensure all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements

Required Qualifications

• Excellent written and verbal communication skills which demonstrate the ability to interact courteously and effectively with both internal and external customers; skills include listening and comprehension, constructive feedback, spelling, grammar, proofreading, and telephone communication

• Demonstrated ability to creatively solve problems and create improvements

• Experience with Word, Excel, Outlook

• Data entry experience

• Understands intent/end state and operates with minimal guidance to meet that intent/end state

• Ability to manage multiple tasks and shifting priorities

• Ability to manage high work volume and oversee a variety of incoming work flows

• A team player capable of operating independently when needed

• Deliver accurate and timely results

• Follows up as needed to effectively resolve an issue

Preferred Qualifications
Previous experience is a plus

Education

High School diploma, G.E.D. or equivalent experience

Anticipated Weekly Hours
40

Time Type
Full time

Pay Range

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.

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 all 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, visithttps://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 05/12/2025

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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