Senior Eligibility Analyst

Job DescriptionCVS/Caremark, the Pharmacy Benefit Management (PBM) division of CVS Health, is looking for an Eligibility Analyst to join our PBM Eligibility Administration Department. As an Eligibility Analyst for a Fortune 10 organization, you will impact and support customers in all areas including Commercial, Medicare, Healthcare Plans & Group Waiver Plans (EGWP).Primary responsibilities of the Eligibility Analyst include: - Provide direct support and oversight to client and vendor eligibility data exchange functions and services- Researching and consulting to improve healthcare data integrity and ensure excellent service delivery - Constantly improving healthcare analytical skills that are needed to perform data analysis - Resolving data enrollment issues on a daily basis - Act as a liaison between clients, vendors, and the IT department when defining business requirements associated with non-standard or customized processes; assist in the identification of potential solutions and approve programming specifications required for testing any non-standard arrangements.- Oversee the validation and confirmation of data feeds from clients to ensure system integrity through regular audits and reconciliation; communicate directly with third party vendors for data exchange set ups and troubleshooting.- Support client implementation efforts by serving as enrollment data and configuration subject matter expert- Initiate and lead projects with eligibility impacts including vendor, client migrations, and client add-on requests.Required Qualifications- 5+ years in healthcare data eligibility, insurance, IT, benefits or data analytics environmentCOVID 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 Qualifications- Ability to match key PBM concepts and data fields across various systems and file layouts such as EDI 834 to ensure consistency and accuracy of data transfers.- Proven track record of execution, testing and maintenance of critical operational tasks.- Proficiency in Access, Excel, and other technical data skills preferred- Strong communication skills with the ability to develop effective work relationships with internal and external stakeholders.- Self-motivated and detail-oriented problem solver- Ability to handle multiple competing priorities in a dynamic environment and collaborate in a team- 5+ years in Eligibility Administration or other relevant background - 4+ years customer service or client-facing experience in a fast-paced environment - Experience in EDI (Electronic Data Interchange) - Understanding of the PBM industry - Experience in a healthcare client facing role - Experience in a fast paced environment - Knowledge of ANSI X12 834 Data Documents - Familiarity with RxClaim and/or AS400EducationHigh School Diploma or GED requiredBachelor Degree preferredBusiness 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: 2025-10-04