Senior Eligibility Consultant

CVS Health•East Lansing, MI

3d•$19 - $39

About The Position

This senior individual-contributor role on the Eligibility team is responsible for accurate, timely eligibility processing and resolving complex enrollment and eligibility issues. The role operates with increasing independence, manages a high volume of work across shifting priorities, and partners with internal teams, clients, and vendors to achieve clear, high-quality outcomes. It also supports team capability by mentoring newer colleagues and helping them transition from classroom training into production work.

Requirements

At least 2 years of industry knowledge and enrollment/eligibility processing experience.
Comfort with professional email communication, including clear documentation, timely updates, and appropriate tone with internal and external partners.
Ability to manage multiple incoming workflows and shifting priorities while remaining organized and responsive.
Experience supporting internal reporting requirements, including tracking work status, documenting outcomes, and meeting reporting deadlines.
Ability to meet required turnaround times while maintaining strong accuracy and quality standards.
Experience coaching, mentoring, or onboarding others in a production environment.
High school diploma, GED, or equivalent experience.

Nice To Haves

Direct experience supporting COBRA and/or Eligibility programs, including familiarity with downstream impacts to claims and member experience.
Experience handling escalated or exception-based eligibility cases involving conflicting inputs, unclear data, or complex retroactivity.
Experience identifying root causes of recurring issues and driving small process improvements that reduce rework.
Experience supporting transitions such as new clients, new processes, or system changes and helping others ramp successfully.
Experience creating or improving job aids, reference guides, or training materials for team use.

Responsibilities

Process policy and eligibility data accurately and on time using administration systems to support claim payment and plan sponsor service expectations.
Investigate and resolve complex eligibility and enrollment issues, identify root causes, and drive issues to closure.
Coordinate with internal teams, clients, and vendors to share information, remove blockers, and achieve positive outcomes.
Anticipate potential issues and act early to prevent rework, delays, or downstream impacts.
Contribute to process improvements that strengthen accuracy, efficiency, and consistency across workflows.
Support reporting and data discrepancy work by evaluating options, documenting trade-offs, and recommending workable paths forward.
Design and deliver transition support for newly hired colleagues moving from classroom learning into the production environment.
Coach and mentor junior team members through side-by-side support, feedback, and knowledge sharing.
Manage multiple tasks and shifting priorities while maintaining quality and attention to detail.
Work effectively as part of a team and independently when needed.