As an Eligibility Consultant you will have the opportunity to develop and maintain strong client relationships with our Medicare Advantage Group customers. Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns.
As an Eligibility Consultant, your success will be driven by meeting client satisfaction. Using your skills and knowledge to define problems, participate in improvement efforts, and manage processes to ensure our internal and external customer needs are met. The ability to deliver results for our clients will be a key factor to your success in this role.
You will accomplish this by:
- Administer client needs where you respond, research, and resolve eligibility and other enrollment related discrepancies involving member specific information.
- Participate in inter-departmental process reviews and training including special projects.
- Complete data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.
- Participate in developing client action plans by working directly with Plan Sponsor Liaisons, Sales and other assigned account team members to achieve positive service outcomes.
- Applies Centers for Medicare & Medicaid Services guidance and Aetna policies in addressing eligibility matters.
- Ensures all transactions interface accordingly with downstream system.
- Candidate should have a strong command of Federal Medicare guidelines/requirements & Aetna Medicare Advantage policy.
- Attention to detail and accuracy.
- Data entry experience.
- Problem solving skills.
- Strong organization skills.
- Understands the impact of work to other teams and downstream support areas.
- Ability to analyze and research data to make appropriate corrections as necessary.
- Strong verbal and written communication skills.
Additional Job Information
- Ability to analyze and research data to make appropriate corrections as necessary
- Understands the impact of work to other teams and downstream support areas
- Strong verbal and written communication skills
- Sound understanding of system errors and how to resolve efficiently
- Strong organization skills
- Problem solving skills
- Attention to detail and accuracy
High School diploma, G.E.D. or equivalent experience
Percent of Travel Required
0 - 10%
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.
We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.
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