Eligibility Consultant

CVS Health•East Lansing, MI

3d•$17 - $31•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 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 on-going 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 have 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

1+ years of excellent customer service skills with the ability to communicate effectively with both internal and external customers.
1+ years of Data entry experience.
Must be able to type at least 35WPM
Excellent verbal and written communication skills including articulation, spelling, grammar, proofreading, and telephone skills.
Experience with Word and proficient in Excel.
High School diploma or G.E.D.

Nice To Haves

Basic knowledge of Health Insurance industry
6 months of more experience with QuickBase

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 on-going 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 have 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.