Eligibility Consultant (Phoenix, AZ)

CVS Health • Phoenix, AZ

3d • $17 - $28 • Onsite

About The Position

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 As an Eligibility Consultant, you will respond, research, and resolve eligibility and other enrollment related issues/requests involving member specific information. This person must have a full understanding of Medicare guidelines and the global processes within Enrollment Operations. They will manually process eligibility and enrollment updates across multiple systems; resolve tasks and requests within required turnaround time; and analyze and validate operational fallout reports and resolve record exceptions accordingly. The Eligibility Consultant will also participate in special projects as needed, as well as in inter-departmental process reviews and training. Job duties include: Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns. Maintains enrollment databases and coordinates electronic transfer of eligibility data. Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes. Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure, and benefit parameters in addressing eligibility matters. Develops tools, and provides coding supplements, tape specifications, and error listing to clients/vendors. Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements. Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools; and tracks results to avoid potential problems and better address ongoing service issues. Partners with other team functions to coordinate the release of eligibility, plan structure, and benefit information. Completes required set-up of policy and eligibility screens in order to activate system processing of plan benefits. Codes system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products (i.e., ID cards). Ensures that legislation and compliance has been properly adhered to with regard to Plan Sponsor and/or member activity. Utilizes and interprets online resources to understand customer’s account structure and benefits. May assist with the development of such resources. Determines and communicates standard service charges to internal/external customers related to electronic eligibility activities; may negotiate and communicate charges pertaining to non-standard services. Ensures all communications with clients, third-party administrators, and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.

Requirements

• 2-3 years of experience with eligibility verification.
• 2-3 years of experience with data entry and customer service.
• Demonstrated proficiency with Microsoft Office Suite.
• Must reside within a commutable distance to Phoenix, AZ.

Nice To Haves

• Previous experience with Medicaid and/or Medicare.
• Previous work from home experience.
• Strong time management skills.
• Ability to operate independently.
• Excellent organization skills.

Responsibilities

• Verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns.
• Maintains enrollment databases and coordinates electronic transfer of eligibility data.
• Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.
• Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure, and benefit parameters in addressing eligibility matters.
• Develops tools, and provides coding supplements, tape specifications, and error listing to clients/vendors.
• Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements.
• Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools; and tracks results to avoid potential problems and better address ongoing service issues.
• Partners with other team functions to coordinate the release of eligibility, plan structure, and benefit information.
• Completes required set-up of policy and eligibility screens in order to activate system processing of plan benefits.
• Codes system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products (i.e., ID cards).
• Ensures that legislation and compliance has been properly adhered to with regard to Plan Sponsor and/or member activity.
• Utilizes and interprets online resources to understand customer’s account structure and benefits. May assist with the development of such resources.
• Determines and communicates standard service charges to internal/external customers related to electronic eligibility activities; may negotiate and communicate charges pertaining to non-standard services.
• Ensures all communications with clients, third-party administrators, and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

What This Job Offers

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