Enrollment & Eligibility Specialist

CVS Health; Carson City (NV); On-site; USD 23,000 - 47,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking an Enrollment Specialist to verify member statuses, update records, and handle eligibility inquiries. You will maintain databases, coordinate data transfers, and resolve both standard and complex enrollment issues with clients, field offices, and claim operations.

Responsibilities include applying regulatory guidelines, developing reporting tools, and ensuring HIPAA compliance while coordinating with IT and vendors on non-standard arrangements.

Qualifications

• 1+ years of excellent customer service skills with the ability to communicate effectively with both internal and external customers.
• 1+ years of Data entry experience.
• Must be able to type at least 35WPM
• Excellent verbal and written communication skills including articulation, spelling, grammar, proofreading, and telephone skills.
• Experience with Word and proficient in Excel.

Responsibilities

• Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses enrollment questions or concerns.
• Maintains enrollment databases and coordinates electronic transfer of eligibility data.
• Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes.
• Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.
• Develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors.
• Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements.
• Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid potential problems and better address on-going service issues.
• Partners with other team functions to coordinate the release of eligibility, plan structure and benefit information.
• Completes required set-up of policy and eligibility screens in order to activate system processing of plan benefits.
• Codes system screens, policy, and structure to support downstream processes and the generation and release of Member and Plan Sponsor products (i.e., ID cards).
• Ensures that legislation and compliance has been properly adhered to with regard to Plan Sponsor and/or member activity.
• Utilizes and interprets on line resources to understand customer’s account structure and benefits.
• May assist with the development of such resources.
• Determines and communicates standard service charges to internal/external customers related to electronic eligibility activities; may negotiate and communicate charges pertaining to non-standard services.
• Ensures all communications with clients, third-party administrators and/or brokers involving sensitive member data adhere to HIPAA compliance requirements.

Skills

Customer service

Data entry

Typing 35 WPM

Verbal and written communication

Excel

Word

Education

High School diploma or GED

Tools

QuickBase

Job description

CVS Health is seeking an Enrollment Specialist to verify member statuses, update records, and handle eligibility inquiries. You will maintain databases, coordinate data transfers, and resolve both standard and complex enrollment issues with clients, field offices, and claim operations.

Responsibilities include applying regulatory guidelines, developing reporting tools, and ensuring HIPAA compliance while coordinating with IT and vendors on non-standard arrangements.