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Eligibility Consultant - Electronic ID-8196

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.

 

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Position Summary

In this role as an Eligibility Analyst, you will:

- Verify enrollment status, make changes to member/client records, and address a variety of enrollment questions or concerns

- Maintain enrollment databases and coordinate transfer of eligibility data

- Utilize and interpret online resources to understand account structure and benefits, may assist with the development of such resources

- Respond, research, and resolve eligibility and other enrollment related issues involving member specific information by working directly with clients, vendors, and internal partners to achieve positive service outcomes

- Apply all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters

- Act as the liaison between clients, vendors, and the IT department defining and identifying business requirements and solutions for non-standard arrangements

- Ensure all transactions interface accordingly with downstream systems; test and validate data files for new or existing clients using system tools and track results to avoid potential problems and better address on-going service issues

- Partner with other team functions to coordinate the release of eligibility, plan structure and benefit information

- Complete required set-up of policy and eligibility screens in order to activate system processing of plan benefits

- Code system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products

- Ensure all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements



Required Qualifications

- Excellent written and verbal communication skills which demonstrate the ability to interact courteously and effectively with both internal and external customers; skills include listening and comprehension, constructive feedback, spelling, grammar, proofreading, and telephone communication

- Demonstrated ability to creatively solve problems and create improvements

- Experience with Word, Excel, Outlook

- Data entry experience

- Understands intent/end state and operates with minimal guidance to meet that intent/end state

- Ability to manage multiple tasks and shifting priorities

- Ability to manage high work volume and oversee a variety of incoming work flows

- A team player capable of operating independently when needed

- Deliver accurate and timely results

- Follows up as needed to effectively resolve an issue



Preferred Qualifications
Previous experience is a plus

Education

High School diploma, G.E.D. or equivalent experience

 

 

Anticipated Weekly Hours

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

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With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

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6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

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8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

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This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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