Eligibility Consultant – Paper Ops

Job not on LinkedIn

🔥 15 hours ago

🏈 Alabama, Connecticut, +29 more states – Remote

🏈 Alabama – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🌾 Nebraska – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote

💵 $17 - $34 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

⚙️ Operations

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Support multiple health plans • Verify enrollment status and make changes to member/client records • Address enrollment questions and concerns • Maintain enrollment databases • Coordinate transfer of non-electronic eligibility data • Research and resolve eligibility and billing issues involving member-specific information • Work with clients, field marketing offices, and/or local claim operations to achieve positive service outcomes • Monitor daily status reports and assess output for trends affecting service levels • Apply technical requirements, legislative/regulatory policies, account structure, and benefit parameters to eligibility matters • Validate benefit plan enrollment information for accuracy and completeness • Coordinate distribution and customization requests for membership ID cards • Complete screen coding and data entry for member-specific and plan sponsor products, including ID cards, change applications, audit lists, in-force lists, HIPAA certificates, and reports • Complete data entry for new enrollments, changes, and terminations • Review and correct transaction errors affecting eligibility interfaces • Prepare eligibility/enrollment information for imaging • Interpret and translate client benefits and account structures against GEBAR, AAS, and CCI systems/applications • Determine and communicate standard service charges for paper eligibility activities, including negotiating and communicating charges for non-standard services when needed • Partner with other team functions to coordinate release of eligibility and benefit plan information • Reproduce group bills when requested by clients

🎯 Requirements

• Attention to detail and accuracy • Problem solving skills • Strong organization skills • Understanding of the impact of work to other teams and downstream support areas • Ability to analyze and research data to make appropriate corrections • Strong verbal and written communication skills • Workplace flexibility and ability to adapt to change • Ability to maintain work schedule within EST time zone, 9:30am–6:00pm EST • Availability for overtime, with possible weekend work where needed • High School Diploma or equivalent • Preferred: Knowledge of Health Care and/or MCO’s • Preferred: Knowledge of Enrollment • Preferred: Knowledge of Medicaid and/or Medicare • Preferred: Comfort learning different systems and using Excel (VLOOKUP)

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Overtime availability, with possible weekend work where needed