Advanced Eligibility Consultant

CVS Health•East Lansing, MI

22h•Onsite

About The Position

The Analyst, Eligibility (Advanced Analyst) serves as a pivotal resource, entrusted with the stewardship of the organization’s most intricate and high-value client portfolios. This role is characterized by the autonomous management and resolution of multifaceted eligibility issues, requiring the translation of strategic directives and organizational intent into executable, results-driven initiatives with minimal oversight. Advanced Analysts operate in a consultative capacity, engaging cross-functionally with internal departments, external clients, and broker partners to deliver expert guidance and solutions. In addition to functioning as the principal escalation point prior to Manager or Director intervention, Advanced Analysts are responsible for the ongoing development and mentorship of junior staff, the design and implementation of comprehensive training programs, the orchestration and alignment of daily operational objectives, and the identification and execution of process optimization strategies. Subject matter expertise is leveraged to drive continuous improvement and operational excellence across the eligibility function.

Requirements

3-4 years experience as an Eligibility Consultant, with a proven track record of managing complex eligibility and policy data for high-value plan sponsors.
Advanced proficiency in the accurate and timely processing of eligibility data, ensuring alignment with client requirements and organizational standards.
Ability to synthesize organizational intent and end-state objectives, operating with a high degree of autonomy to achieve desired outcomes.
Exceptional organizational skills, with the capacity to manage multiple concurrent priorities in a dynamic environment.
Demonstrated ability to function both independently and as an integral member of a collaborative team.
Consistent delivery of precise and timely results, with effective delegation and follow-up as required.
Experience in coaching and mentoring junior colleagues, including the design, development, and facilitation of transitional training programs to support the seamless integration of new hires from classroom instruction to full productivity.
Proven ability to identify, recommend, and implement process improvements and operational efficiencies.
High school diploma, G.E.D. and equivalent experience.

Nice To Haves

Experience in processing policy and eligibility data with a high degree of accuracy and timeliness, ensuring that all services and products consistently align with the specific requirements of plan sponsors.
Experience in coaching, mentoring, and developing others within a team or organizational setting.
Demonstrated leadership in complex eligibility operations.

Responsibilities

Autonomous management and resolution of multifaceted eligibility issues.
Translate strategic directives and organizational intent into executable, results-driven initiatives.
Operate in a consultative capacity, engaging cross-functionally with internal departments, external clients, and broker partners.
Function as the principal escalation point prior to Manager or Director intervention.
Ongoing development and mentorship of junior staff.
Design and implementation of comprehensive training programs.
Orchestration and alignment of daily operational objectives.
Identification and execution of process optimization strategies.
Leverage subject matter expertise to drive continuous improvement and operational excellence across the eligibility function.