Eligibility Consultant

CVS Health

. Verify enrollment status and make changes to member/client records .

Posted 9/24/2026full-timeUnited StatesJunior💰 $17 - $34 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing enrollment processes, ensuring compliance with legislative and regulatory policies, and providing exceptional customer service. Proficient in data entry, communication, and utilizing tools like Excel and QuickBase to support eligibility and enrollment operations.

Highest-signal resume keywords

Customer Service ExperienceData Entry SkillsExcel ProficiencyQuickBase ExperienceHIPAA Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data EntryEligibility VerificationCoding SpecificationsDatabase ManagementTechnical Requirements Application

Soft Skills

Verbal CommunicationWritten CommunicationProblem SolvingCollaboration

Tools & Technologies

ExcelWordQuickBase

Certifications & Qualifications

High School DiplomaG.E.D.

Industry Keywords

Health InsuranceEnrollment ProcessesLegislative ComplianceMember Data ManagementBenefit Parameters

About the role

Key responsibilities & impact

Verify enrollment status and make changes to member/client records
Address enrollment questions and concerns
Maintain enrollment databases and coordinate electronic eligibility data transfers
Research and resolve eligibility and enrollment issues involving member-specific information
Collaborate with clients, field marketing offices, and local claim operations
Apply technical requirements, legislative/regulatory policies, account structures, and benefit parameters
Develop tools and provide coding supplements, tape specifications, and error listings to clients/vendors
Liaise with clients, vendors, and IT to define business requirements for non-standard reporting
Identify solutions and approve programming specifications for testing non-standard arrangements
Test and validate eligibility data files and track results
Coordinate the release of eligibility, plan structure, and benefit information
Set up policy and eligibility screens to activate plan-benefit processing
Code system screens, policies, and structures for downstream processes and member/plan sponsor products
Ensure legislative and compliance adherence
Interpret online resources to understand customer account structures and benefits
Determine and communicate standard service charges and negotiate non-standard service charges
Ensure communications involving sensitive member data comply with HIPAA requirements

Requirements

What you’ll need

1+ years of excellent customer service experience
1+ years of data entry experience
Ability to type at least 35 WPM
Excellent verbal and written communication skills, including articulation, spelling, grammar, proofreading, and telephone skills
Experience with Word
Proficiency in Excel
High School diploma or G.E.D.
Basic knowledge of the health insurance industry preferred
6 months or more of QuickBase experience preferred

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program in addition to base pay
Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being