Advanced Eligibility Consultant

CVS Health

4d

About The Position

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: 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.

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.

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees