Sr Eligibility Consultant Ops

Job DescriptionThe Sr Eligibility Consultant Role plays a critical role in working with our Medicare Part D member clients to determine eligibility and perform various enrollment activities. Interfacing with plan members, the position will work in accordance with the Center for Medicare/Medicaid Services (CMS) guidelines to ensure regulatory compliance. This position requires a strong focus around accurate and timely customer support to ensure client enrollment and retention. The Sr Eligibility Consultant Role will need to prioritize daily tasks and work items in queue, manage turnaround times, and manage items that need escalation. The position will partner cross-functionally with various operational business units while supporting departmental objectives within company and regulatory guidelines.Required Qualifications Meet monthly established quality goal on a consistent basis Meet monthly established TAT goal on a consistent basis Meet monthly established productivity goal on a consistent basis Be able to determine section of guidance related to task type being worked Perform OBCs with a call script Provide outcome to member that doesn't result in a CTM Be able to enter information in excel and sort data Read and Interpret Work Instructions for enrollment work types Manage daily priority of workflow tasksCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsAbility to make outbound calls, computer knowledge and microsoft office knowledge.EducationHigh School diploma or GEDBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-01