Advanced Eligibility Consultant

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven 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

The Advanced Eligibility Consultant is responsible for our most complex and highest valued clients. The Advanced Eligibility Consultant will also work and resolve complex issues. They translate direction and intent into actionable items while operating with minimal supervision. This person is consultative in nature when working with other departments, clients, and brokers. They coach and mentor junior staff, develop and execute training plans, coordinate and set daily objectives, identify and implement process improvements and efficiencies, and function as our highest level of escalation prior to manager/director involvement.

The Advanced Eligibility Consultant will establish and maintain processes regarding billing and claims processing, insurance verification and authorization, revenue cycle management, and compliance & documentation, as well as customer service and issue resolution. They will reconcile and solve issues to ensure accurate billing, facilitate smooth revenue flow, maintain compliance, and provide satisfactory customer experiences.

Required Qualifications:

• 2+ 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.
• Must reside in Lansing, MI or Plymouth, MN.
• Ability to work a hybrid schedule (3 days in the office per week).

Preferred Qualifications:

• Experience using QuickBase.
• Proficiency in Microsoft Outlook, Teams, Windows, and Excel.
• Ability to manage multiple tasks/priorities.
• Adaptable and quick to grasp new concepts, with a solid foundation in auditing and a proven ability to think creatively and develop innovative solutions.
• Understands intent/end state and operates with minimal guidance to meet that intent/end state.
• Team player capable of operating independently when needed.
• Ability to provide accurate and timely results.
• Ability to delegate and follow up as needed.
• Ability to coach and mentor others.
• Experience as a Senior Eligibility Consultant and/or Senior Eligibility Analyst.

education:

• Bachelor’s degree or equivalent experience (high school diploma or GED + 4 years of relevant experience).

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$43,888.00 – $93,574.00

This pay range represents the base hourly rate or base annual full-time 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 short-term 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.
• No-cost 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 https://jobs.cvshealth.com/us/en/benefits

We anticipate the Application window for this opening will close on: 07/03/2025

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

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