Senior Eligibility Consultant

CVS Health • Amherst, NY

13d • $19 - $39

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 In this role as a Senior Eligibility Consultant you will: Process accurate and timely policy and eligibility data utilizing administration systems for claim payment purposes and product production ensuring services and products meet plan sponsor needs Collaborate with business partners to understand enterprise initiatives and goals Respond to eligibility and other enrollment related issues Partner directly with clients, vendors, internal teams, and/or local claim operation to resolve problems and achieve positive outcomes Anticipate and prevent problems and roadblocks before they occur Solve complex problems and take a new perspective on existing solutions Design, develop, and deliver transitional training processes and procedures to smooth the transition for newly hired employees from formalized classroom training to the department’s production environment; mentor junior team members Assist with and/or evaluate recommendations involving eligibility reporting solutions and negotiate with internal/external clients Deliver consulting services in support of data discrepancies and/or involving reporting alternatives

Requirements

• 2+ years experience as an Eligibility Consultant
• Proficiency in processing accurate and timely policy and eligibility data, ensuring services and products meet the plan sponsor needs
• Understands intent/end state and operates with minimal guidance to meet that intent/end state
• Ability to manage multiple tasks and shifting priorities
• A team player capable of operating independently when needed
• Provides accurate and timely results
• Delegates and follows up as needed
• Coaches and mentors others
• Ability to manage high work volume and oversee a variety of incoming work flows

Nice To Haves

• Industry knowledge
• Enrollment processing experience

Responsibilities

• Process accurate and timely policy and eligibility data utilizing administration systems for claim payment purposes and product production ensuring services and products meet plan sponsor needs
• Collaborate with business partners to understand enterprise initiatives and goals
• Respond to eligibility and other enrollment related issues
• Partner directly with clients, vendors, internal teams, and/or local claim operation to resolve problems and achieve positive outcomes
• Anticipate and prevent problems and roadblocks before they occur
• Solve complex problems and take a new perspective on existing solutions
• Design, develop, and deliver transitional training processes and procedures to smooth the transition for newly hired employees from formalized classroom training to the department’s production environment; mentor junior team members
• Assist with and/or evaluate recommendations involving eligibility reporting solutions and negotiate with internal/external clients
• Deliver consulting services in support of data discrepancies and/or involving reporting alternatives

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: Senior
• Education Level: High school or GED