Senior Eligibility Consultant at CVS Health

Lansing, Michigan, United States

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Not SpecifiedCompensation

Senior (5 to 8 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

2+ years experience as an Eligibility Consultant
Proficiency in processing accurate and timely policy and eligibility data, ensuring services and products meet the plan sponsor needs
Understands intent/end state and operates with minimal guidance to meet that intent/end state
Ability to manage multiple tasks and shifting priorities
A team player capable of operating independently when needed
Provides accurate and timely results
Delegates and follows up as needed
Coaches and mentors others
Ability to manage high work volume and oversee a variety of incoming work flows
High School diploma, G.E.D. or equivalent experience

Responsibilities

Process accurate and timely policy and eligibility data utilizing administration systems for claim payment purposes and product production ensuring services and products meet plan sponsor needs
Collaborate with business partners to understand enterprise initiatives and goals
Respond to eligibility and other enrollment related issues
Partner directly with clients, vendors, internal teams, and/or local claim operation to resolve problems and achieve positive outcomes
Anticipate and prevent problems and roadblocks before they occur
Solve complex problems and take a new perspective on existing solutions
Design, develop, and deliver transitional training processes and procedures to smooth the transition for newly hired employees from formalized classroom training to the department’s production environment; mentor junior team members
Assist with and/or evaluate recommendations involving eligibility reporting solutions and negotiate with internal/external clients
Deliver consulting services in support of data discrepancies and/or involving reporting alternatives

Skills

Eligibility Processing

Policy Data Management

Claim Payment Systems

Client Collaboration

Problem Solving

Training Development

Mentoring

Eligibility Reporting

Data Discrepancy Resolution

Consulting Services

CVS Health

Comprehensive pharmacy and healthcare services

About CVS Health

CVS Health operates a large network of retail pharmacies and walk-in medical clinics across the United States, providing a variety of health-related products and services. Their offerings include prescription medications, over-the-counter health products, and beauty items, as well as pharmacy benefits management and specialty pharmacy services. CVS Health's integrated business model allows them to serve individual consumers, businesses, and communities effectively, with a focus on improving health outcomes and reducing healthcare costs. Unlike many competitors, CVS Health combines pharmacy services with medical care, making it easier for patients to access quality healthcare. The company's goal is to enhance access to healthcare and support individuals in achieving better health.

Woonsocket, Rhode IslandHeadquarters

1963Year Founded

DEBTCompany Stage

Healthcare, Consumer GoodsIndustries

10,001+Employees

Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Company Equity

Wellness Program

Professional Development Budget

Paid Vacation

Paid Holidays

Risks

Legal challenges related to opioid prescriptions could harm CVS's reputation and finances.

The DOJ's intervention in a whistleblower lawsuit may increase legal costs for CVS.

The Horizon Organic Milk recall exposes potential vulnerabilities in CVS's supply chain.

Differentiation

CVS Health operates over 9,600 retail pharmacies and 1,100 walk-in clinics nationwide.

The company integrates pharmacy benefits management with specialty pharmacy services for comprehensive care.

CVS Health offers tailored medication plans through personalized medicine and pharmacogenomics.

Upsides

Expansion of telehealth services allows CVS to reach more patients remotely.

Increased consumer interest in wellness boosts demand for CVS's health-related products.

The trend towards value-based care aligns with CVS's integrated healthcare approach.

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