Senior Eligibility Specialist

CVS Health•Plymouth, MN

1d•$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 This role is a senior individual contributor on the Eligibility team, responsible for accurate, timely eligibility processing and resolution of complex enrollment and eligibility issues. Senior Eligibility Consultants operate with increasing independence, manage a high volume of work across shifting priorities, and partner with internal teams, clients, and vendors to drive clear, high-quality outcomes. You’ll also support team capability by mentoring newer colleagues and helping bridge formal training into day-to-day production work. In this role as a Senior Eligibility Consultant, you will: Process policy and eligibility data accurately and on time using administration systems to support claim payment and plan sponsor service expectations Resolve complex eligibility and enrollment issues by investigating discrepancies, identifying root causes, and driving issues to closure Partner with internal teams, clients, and vendors to coordinate information, remove blockers, and achieve positive outcomes Anticipate potential issues and take action 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 helping evaluate options, documenting trade-offs, and recommending workable paths forward Design and deliver transition support for newly hired colleagues as they move 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 Contribute as a strong team player who can operate independently when needed

Requirements

2+ years experience industry knowledge and enrollment/eligibility processing experience
Demonstrated 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 staying organized and responsive
Experience supporting internal reporting requirements, including tracking work status, documenting outcomes, and meeting reporting deadlines
Proven ability to meet required turnaround times while maintaining strong accuracy and quality standards
Experience coaching, mentoring, or onboarding others in a production environment

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 (conflicting inputs, unclear data, complex retroactivity)
Experience identifying root causes of recurring issues and driving small process improvements that reduce rework
Experience supporting transitions (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
Resolve complex eligibility and enrollment issues by investigating discrepancies, identifying root causes, and driving issues to closure
Partner with internal teams, clients, and vendors to coordinate information, remove blockers, and achieve positive outcomes
Anticipate potential issues and take action 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 helping evaluate options, documenting trade-offs, and recommending workable paths forward
Design and deliver transition support for newly hired colleagues as they move 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
Contribute as a strong team player who can operate independently when needed