Eligibility Consultant - Paper Ops

Enrollment Representative

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.

The Enrollment Representative position will be supporting multiple health plans. 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 transfer of non-electronic eligibility data.

Responds, researches, and resolves eligibility and/or billing related issues involving member specific information. Works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes. Monitors daily status reports assessing output for developing trends potentially impacting service levels. 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 screen coding and data entry requirements related to the systems processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates and various reports). Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations. When necessary, reviews and corrects transaction errors impacting eligibility interfaces and prepares eligibility/enrollment information for imaging. Interprets and translates client benefits and supporting account structure against internal systems/applications (i.e., GEBAR, AAS, and CCI). Determines and communicates standard service charges to internal/external customers related to paper eligibility activities; May include negotiating and communicating charges pertaining to non-standard services. Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients.

Required Qualifications:

• 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.
• Required to maintain work schedule within EST time zone (9:30am- 6:00pm EST).
• Ability to remain available for overtime, with possible weekend work where needed.

Preferred Qualifications:

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

Education:

• High School Diploma or equivalent.

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $17.00 - $34.15

Great benefits for great people. We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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.

We anticipate the application window for this opening will close on: 09/05/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.