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Job Details


CVS Health

Eligibility Consultant - Paper Ops (1983896BR)

Pharmaceuticals

All

Yearly

No

Delaware, United States

Job Description
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
terminations. (*)

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

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.
Workplace flexibility - ability to adapt to change

COVID Requirements


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.

Preferred Qualifications
Knowledge of Health Care and/or MCO’s.
Knowledge of Enrollment.
Knowledge Medicaid and/or Medicare.
Knowledge and comfortability with learning different systems and using Excel

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.