CVS Health Eligibility Consultant in Phoenix, Arizona
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 has been properly adhered to with regard to Plan Sponsor and/or member activity.
Utilizes and interprets on line 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.
Medicaid experience preferred
Strong data entry skills
Customer Service experience
Experience in production based roles
Experience using Microsoft Excel
Additional Job Information
Ability to analyze and research data to make appropriate corrections as necessary.Understands the impact of work to other teams and downstream support areas.Strong verbal and written communication skills.Sound understanding of system errors and how to resolve efficiently.Strong organization skills.Problem solving skills.Attention to detail and accuracy.
High School diploma, G.E.D. or equivalent experience
Percent of Travel Required
0 - 10%
Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.