Eligibility Consultant-Hybrid Lansing MI
Eligibility Consultant-Hybrid Lansing MI
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$ 17 - 31
1 Vacancy
Job Description
At CVS Health were building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.
As the nations leading health solutions company we reach millions of Americans through our local presence digital channels and more than 300000 purposedriven 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.
Role requires candidate to be located in Lansing MI and in office 3 days out of the week.
Position Summary
- 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 nonstandard reporting; identifies potential solutions and approves programming specifications required for testing any nonstandard 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 ongoing service issues.
- Partners with other team functions to coordinate the release of eligibility plan structure and benefit information.
- Completes required setup 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 customers 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 nonstandard services.
- Ensures all communications with clients thirdparty administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.
Required Qualifications
- 1 years of excellent customer service skills with the ability to communicate effectively with both internal and external customers.
- 1 years of Data entry experience.
- Must be able to type at least 35WPM
- Excellent verbal and written communication skills including articulation spelling grammar proofreading and telephone skills.
- Experience with Word and proficient in Excel.
Preferred Qualifications
- Basic knowledge of Health Insurance industry
- 6 months of more experience with QuickBase
Education
- High School diploma G.E.D. or equivalent experience
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$17.00 $31.30This pay range represents the base hourly rate or base annual fulltime salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience education geography and other relevant factors. This position is eligible for a CVS Health bonus commission or shortterm incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers patients members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
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.
Nocost 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.
For more information visit anticipate the application window for this opening will close on: 04/15/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.
Required Experience:
Contract
Employment Type
Full-Time
