Remote Eligibility Consultant — Health Plan Enrollment

MaziCTools; United States; Remote; USD 42,000 - 52,000; Full time

Job summary

CVS Health is seeking an Enrollment Specialist to verify enrollment status, update member records, and resolve questions across client and vendor partners. You will manage databases, transfer eligibility data, and ensure data integrity in systems used for benefits processing.

You will interpret resources to understand account structures, assist with implementation details, and coordinate with IT, operations and client teams while ensuring HIPAA compliance and accurate communications.

Qualifications

• Excellent written and verbal communication with customers and colleagues.
• Ability to solve problems creatively and improve processes.
• Proficient in Word, Excel, and Outlook.
• Data entry experience and ability to manage multiple tasks.
• Self-directed with minimal guidance and able to handle high workload.
• Team player capable of independent work when needed.
• Ability to deliver accurate and timely results and follow up when needed.

Responsibilities

• Verify enrollment status and handle changes to member records.
• Maintain enrollment databases and coordinate transfer of eligibility data.
• Utilize online resources to understand account structure and benefits.
• Respond to eligibility and enrollment questions with clients, vendors, and internal partners.
• Define business requirements with clients, vendors, and IT for non-standard arrangements.
• Ensure transactions interface with downstream systems and test data files.
• Coordinate release of eligibility, plan structure and benefit information.
• Set up policy and eligibility screens to activate processing of plan benefits.
• Code system screens and structure to support downstream processes and reporting.
• Ensure HIPAA compliance in communications with clients and brokers.

Skills

Communication

Problem solving

Data entry

Multitasking

Team player

Independent work

Education

High School Diploma, GED or equivalent experience

Tools

Word

Excel

Outlook

Job description

CVS Health is seeking an Enrollment Specialist to verify enrollment status, update member records, and resolve questions across client and vendor partners. You will manage databases, transfer eligibility data, and ensure data integrity in systems used for benefits processing.

You will interpret resources to understand account structures, assist with implementation details, and coordinate with IT, operations and client teams while ensuring HIPAA compliance and accurate communications.