Lead Eligibility Specialist

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.

Position Summary

In this role as a Lead Eligibility Specialist you will:

• Oversee and ensure the accuracy and compliance of eligibility protocols and standards for department processes.
• Analyze data and conduct verification checks to ensure the accuracy and completeness of all documentation.
• Create tools gather data and conduct analysis in the development of processes to define and measure across the department and multifunctional areas.
• Lead and assist with new products and services impacting the department.
• Identify and implement enhancements to processes and systems resulting in operational efficiencies and improvements.
• Ensure full compliance with relevant regulations contractual obligations and internal policies when assessing eligibility data and department processes.
• Evaluate complex or high visibility cases identify risk and recommend appropriate measures to manage risk.
• Collaborate with other departments to address inquiries clarify eligibility requirements enhance processes and resolve concerns.
• Solve complex problems take a new perspective on existing solutions research and respond to eligibility and other enrollment related issues.
• Identify opportunities to streamline and enhance the eligibility determination process making key recommendations to management for review.
• Generate reports and analyze eligibility data to identify trends patterns and insights.
• Develop training materials and conduct training sessions for employees or stakeholders involved in or connected with the eligibility process.
• Manage assigned projects and ensure project plans and work tasks are in alignment with overall department and organizational goals; manage multiple tasks and shifting priorities.
• Operate independently and take initiative anticipate and prevent problems and roadblocks before they occur provide accurate and timely results.

Required Qualifications:

• 35 years of experience with eligibility particularly within the commercial health insurance industry including a demonstrated proficiency in processing accurate and timely policy and eligibility data ensuring services and products meet the plan sponsor needs.
• 2 years of experience analyze large data sets from multiple data sources.
• Must reside in Lansing MI or Plymouth MN.
• Ability to work a hybrid schedule 3 days in the office per week).

Preferred Qualifications:

• Possesses sound knowledge of Meritain operational processes.
• Experienced with analytic tools/languages such as Tableau Access etc. in order to better analyze large data sets from multiple data sources.
• Ability to successfully interact with members across business units and with external clients.
• Ability to communicate effectively and succinctly with a diverse range of stakeholders both verbally and on paper and with all levels of an organization.
• Ability to manage high work volume and oversee a variety of incoming workflows managing multiple tasks and shifting priorities.
• Provides accurate and timely results delegates and follows up as needed.
• Excellent written and verbal communication skills which demonstrate the ability to interact courteously effectively and succinctly with a diverse range of stakeholders across business units with both internal and external customers; skills include listening and comprehension constructive feedback spelling grammar proofreading and telephone communication
• Demonstrated ability to creatively solve problems and create improvements.

Education:

Bachelor Degree or equivalent work experience(high school diploma 4 years of relevant experience).

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This 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: 05/13/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.