CVS Health
Harrisburg, Pennsylvania, United States
Eligibility Cnslt - Paper-OPS
Posted over 1 month ago
Job Description
Job Description
Eligible to Apply Anywhere Within US
Harrisburg, PA based position supporting multiple health plans. The Enrollment Representative under general supervision, verifies enrollment status, verifies COB, makes changes to member records, updates CVS and addresses a variety of enrollment /COB questions or concerns. Maintains members demographics, eligibility and other insurance coverage in system.
Responds, researches, and resolves eligibility claims related issues involving member specific information; Works directly with Health Plans 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 eligibility information for accuracy and completeness; partnering with appropriate internal/external support areas when needed. Enters all requirements related to the systems processes impacting the generation and release of member-specific (e.g., ID cards and Welcome packets) 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. Determines and communicates standard service charges to internal/external customers related to eligibility activities; Partners with other team to coordinate the release of eligibility information.
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.
Preferred Qualifications
- Functional - Customer Service - Customer Service
- Plan Sponsor - Eligibility - HMO/1-3 Years
- Functional - Claims - Claims Administration - coordination of benefits (COB) verification/1-3 Years
- Functional - Customer Service - Customer Service
- Plan Sponsor - Enrollment - HMO/1-3 Years
Education
- High School diploma, G.E.D. or equivalent experience.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
Eligible to Apply Anywhere Within US
Harrisburg, PA based position supporting multiple health plans. The Enrollment Representative under general supervision, verifies enrollment status, verifies COB, makes changes to member records, updates CVS and addresses a variety of enrollment /COB questions or concerns. Maintains members demographics, eligibility and other insurance coverage in system.
Responds, researches, and resolves eligibility claims related issues involving member specific information; Works directly with Health Plans 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 eligibility information for accuracy and completeness; partnering with appropriate internal/external support areas when needed. Enters all requirements related to the systems processes impacting the generation and release of member-specific (e.g., ID cards and Welcome packets) 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. Determines and communicates standard service charges to internal/external customers related to eligibility activities; Partners with other team to coordinate the release of eligibility information.
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.
Preferred Qualifications
- Functional - Customer Service - Customer Service
- Plan Sponsor - Eligibility - HMO/1-3 Years
- Functional - Claims - Claims Administration - coordination of benefits (COB) verification/1-3 Years
- Functional - Customer Service - Customer Service
- Plan Sponsor - Enrollment - HMO/1-3 Years
Education
- High School diploma, G.E.D. or equivalent experience.
Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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