Advanced Eligibility Consultant

CVS Health • East Lansing, MI

20h • Hybrid

About The Position

The Advanced Eligibility Consultant is responsible for CVS Health’s most complex and highest-valued clients and resolves complex issues. The role translates direction and intent into actionable items while operating with minimal supervision and takes a consultative approach when working with other departments, clients, and brokers. The consultant coaches and mentors junior staff, develops and executes training plans, coordinates and sets daily objectives, identifies and implements process improvements and efficiencies, and serves as the highest level of escalation before manager or director involvement.

The role establishes and maintains processes for billing and claims processing, insurance verification and authorization, revenue cycle management, compliance and documentation, customer service, and issue resolution. It reconciles and resolves issues to ensure accurate billing, smooth revenue flow, compliance, and satisfactory customer experiences. The position requires residence in Lansing, Michigan, or Plymouth, Minnesota, and a hybrid schedule with three days per week in the office.

Requirements

• At least 2 years of experience with eligibility, particularly in the commercial health insurance industry.
• Demonstrated proficiency in processing accurate and timely policy and eligibility data and ensuring services and products meet plan sponsor needs.
• Must reside in Lansing, Michigan, or Plymouth, Minnesota.
• Ability to work a hybrid schedule with 3 days in the office per week.
• High school diploma or GED plus 4 years of relevant experience.

Nice To Haves

• Ability to manage multiple tasks and priorities.
• Ability to understand the intended outcome and operate with minimal guidance to achieve it.
• Team-oriented approach and ability to work independently when needed.
• Ability to provide accurate and timely results.
• Ability to delegate and follow up as needed.
• Ability to coach and mentor others.
• Experience as a Senior Eligibility Consultant and/or Senior Eligibility Analyst.
• Bachelor’s degree.

Responsibilities

• Resolve complex eligibility issues for the most complex and highest-valued clients.
• Translate direction and intent into actionable items while working with minimal supervision.
• Consult with other departments, clients, and brokers.
• Coach and mentor junior staff.
• Develop and execute training plans.
• Coordinate and set daily objectives.
• Identify and implement process improvements and efficiencies.
• Serve as the highest level of escalation before manager or director involvement.
• Establish and maintain processes for billing and claims processing, insurance verification and authorization, revenue cycle management, compliance and documentation, customer service, and issue resolution.
• Reconcile and resolve issues to ensure accurate billing, smooth revenue flow, compliance, and satisfactory customer experiences.
• Process accurate and timely policy and eligibility data to help ensure services and products meet plan sponsor needs.

Benefits

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources to support colleagues’ and their families’ physical, emotional, and financial well-being, subject to eligibility
• Eligible for a CVS Health bonus, commission, or short-term incentive program

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED