Eligibility Consultant-Electronic Position Available In Kennebec, Maine

Eligibility Consultant-Electronic at CVS Health in Augusta, Maine, United States Job Description 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 In this role, as an Eligibility Consultant, 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 electronic transfer of eligibility data. + Respond, research, and resolve eligibility and other enrollment related issues involving member specific information; work directly with clients, vendors and/or local claim operations 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. + Develop tools, and provide coding supplements, file specifications and error listing to clients/vendors. + Act as the liaison between clients, vendors with defining business requirements; identify potential solutions and approve programming specifications required for testing. + 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. + Utilize and interpret online resources to understand customer’s account structure and benefits. + Ensure all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements. Required Qualifications + 1+ years of experience in healthcare/insurance industry customer service with the ability to communicate effectively with both internal and external customers. + 1+ years of data entry experience. + Experience with Microsoft Office products (e.g.; Word, Excel, PowerPoint, Outlook, Teams) Preferred Qualifications + Ability