Newark, DE, United States
Eligibility Consultant - Paper Ops
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
* 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
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
* 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 CST time zone
COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.
You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
* Applicants to be within CST (EST may also apply but would be required to follow CST work schedule).
* Knowledge of Health Care and/or MCOs.
* Knowledge of Enrollment.
* Knowledge Medicaid and/or Medicare.
* Knowledge and comfortability with learning different systems and using Excel (VLOOKUP)
High school Diploma
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. 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.