Senior Eligibility Consultant

4062 Aetna Resources, LLC; East Lansing (MI); On-site; USD 25,000 - 53,000; Full time

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Retirement savings

Wellness programs

Job summary

CVS Health is seeking a Senior Eligibility Consultant to join the Eligibility team. You will process policy and eligibility data, resolve complex enrollment issues, and collaborate with internal teams, clients, and vendors to deliver high-quality outcomes.

You will mentor newer colleagues, bridge training into production work, and support reporting and transition activities while handling multiple priorities with accuracy and strong attention to detail.

Qualifications

• 2+ years experience in enrollment/eligibility processing.
• Clear professional email communication and documentation.
• Ability to manage multiple workflows and shifting priorities.
• Experience supporting internal reporting requirements and deadlines.
• Proven mentoring or onboarding experience in a production environment.
• Direct COBRA or Eligibility program experience (preferred).
• Experience handling escalated eligibility cases and complex scenarios.
• Experience supporting transitions with new clients or processes.
• Experience creating or improving job aids or training materials.

Responsibilities

• Process policy and eligibility data accurately to support claim payments and plan sponsor service expectations.
• Resolve complex eligibility and enrollment issues by investigating discrepancies and driving closure.
• Coordinate information with internal teams, clients, and vendors to unblock and achieve outcomes.
• Anticipate issues and take action to prevent rework or delays.
• Contribute to process improvements for accuracy, efficiency, and consistency.
• Support reporting and data discrepancy work by evaluating options and documenting trade-offs.
• Design and deliver transition support for new hires moving into production.
• Coach and mentor junior staff through side-by-side support and knowledge sharing.
• Manage multiple tasks and shifting priorities while maintaining quality.

Skills

Eligibility processing

Communication

Time management

Mentoring

Reporting

COBRA experience

Education

High School diploma or equivalent

Job description

We’re building a world of health around every individual - shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger - helping to simplify health care one person, one family and one community at a time.

Position Summary

This role is a senior individual contributor on the Eligibility team, responsible for accurate, timely eligibility processing and resolution of complex enrollment and eligibility issues. Senior Eligibility Consultants operate with increasing independence, manage a high volume of work across shifting priorities, and partner with internal teams, clients, and vendors to drive clear, high-quality outcomes. You’ll also support team capability by mentoring newer colleagues and helping bridge formal training into day-to-day production work.

In this role as a Senior Eligibility Consultant, you will:

• Process policy and eligibility data accurately and on time using administration systems to support claim payment and plan sponsor service expectations
• Resolve complex eligibility and enrollment issues by investigating discrepancies, identifying root causes, and driving issues to closure
• Partner with internal teams, clients, and vendors to coordinate information, remove blockers, and achieve positive outcomes
• Anticipate potential issues and take action early to prevent rework, delays, or downstream impacts
• Contribute to process improvements that strengthen accuracy, efficiency, and consistency across workflows
• Support reporting and data discrepancy work by helping evaluate options, documenting trade-offs, and recommending workable paths forward
• Design and deliver transition support for newly hired colleagues as they move from classroom learning into the production environment
• Coach and mentor junior team members through side-by-side support, feedback, and knowledge sharing
• Manage multiple tasks and shifting priorities while maintaining quality and attention to detail
• Contribute as a strong team player who can operate independently when needed

Required Qualifications

• 2+ years experience industry knowledge and enrollment/eligibility processing experience
• Demonstrated comfort with professional email communication, including clear documentation, timely updates, and appropriate tone with internal and external partners
• Ability to manage multiple incoming workflows and shifting priorities while staying organized and responsive
• Experience supporting internal reporting requirements, including tracking work status, documenting outcomes, and meeting reporting deadlines
• Proven ability to meet required turnaround times while maintaining strong accuracy and quality standards
• Experience coaching, mentoring, or onboarding others in a production environment

Preferred Qualifications

• Direct experience supporting COBRA and/or Eligibility programs, including familiarity with downstream impacts to claims and member experience
• Experience handling escalated or exception-based eligibility cases (conflicting inputs, unclear data, complex retroactivity)
• Experience identifying root causes of recurring issues and driving small process improvements that reduce rework
• Experience supporting transitions (new clients, new processes, or system changes) and helping others ramp successfully
• Experience creating or improving job aids, reference guides, or training materials for team use

Education

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

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is: $18.50 - $38.82

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full-time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical coverage, dental coverage, vision coverage, paid time off, retirement savings options, wellness programs, other resources. Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people.

Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.

We anticipate the application window for this opening will close on: 10/02/2026