Eligibility Consultant - Paper Ops

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

Position supports multiple health plans:

• Verify member enrollment status
• Make changes to member - demographics, effective and term dates
• Addresses a variety of enrollment questions or concerns from the health plan / state
• Manual QNXT updates on all fall out edits from the daily, weekly, monthly, quarterly electronic enrollment files
• Manually update urgent request received via email from the health plan / state
• Work claim inquiries (H03s)
• Manually enter temp newborns
• Review and manually update all reconciliation reports received from Finance
• Responds, researches, and resolves eligibility related issues involving member specific information
• Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
• Validates benefit plan enrollment information for assigned clients for accuracy and completeness; coordinates the distribution of membership ID cards and partnering with appropriate internal/external support areas involving any requests for ID card customization.
• Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
• Partners with other team functions to coordinate the release of eligibility and benefit plan information.

• Customer Service Experience Required.
• Attention to detail and accuracy.
• Problem solving skills.
• Strong organization skills.
• Understands the impact of work to other teams and downstream support areas.
• Ability to analyze and research data to make appropriate corrections as necessary.
• Strong verbal and written communication skills.
• Workplace flexibility - ability to adapt to change

• Knowledge of Health Care and/or MCO's.
• Knowledge of Enrollment.
• Knowledge Medicaid and/or Medicare.
• Knowledge and comfortability with learning different systems and using Excel

• High school diploma or equivalent required.

• 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.