Eligibility Consultant

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.Position Summary
As an Eligibility Consultant you will have the opportunity to develop and maintain strong client relationships with our Medicare Group customers. You will be responsible for administrating the groups' eligibility in accordance with the CMS Medicare Advantage guidelines. The Eligibility Consultant will maintain enrollment databases, process all enrollment transactions, and must have a full understanding of Medicare Guidelines and the enrollment processes.You will accomplish this by:

• Administer client needs where you respond, research, and resolve eligibility and other enrollment related discrepancies involving member specific information
• Participate in inter-departmental process reviews and training including special projects
• Participate in client meetings (Conference Calls and/or Onsite meetings)
• Analyze reports and communicate results to clients as you complete data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
• Reconcile enrollment discrepancies between Aetna and clients/vendors
• Participate in developing client action plans by working directly with clients/vendors, sales and other assigned account team members to achieve positive service outcomes
• Applies Centers for Medicare & Medicaid Services guidance and Aetna policies associated with technical requirements and account structure in addressing eligibility matters.
• 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

• 2 + years of prior intermediate experience using Microsoft Office Products; Word, Excel Outlook
• 1 + years professional communication experience in verbal and written form
• 1 + years of experience in gathering, researching, and analyzing data/reports
• 1 + years of Health care, or Insurance related experience

• High School Diploma or General Equivalent Development (GED)

• 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.