Plan Sponsor Service Consultant- Ops

Job Description- Performs a minimum of 2-3 plan sponsor functions daily that may include a combination of enrollment, eligibility, duties. -Utilizes and interprets available resources, standard reference materials, and plan sponsor benefits to ensure customer's benefit administration needs are satisfied. Reviews and corrects transaction errors generated through enrollment and eligibility interfaces. -Researches, resolves and responds to eligibility and/or billing inquiries generated from Plan Sponsors, third party vendors, Service Centers, marketing offices, and other external entities/business partners.-Performs multiple functions including enrollment reconciliation, reconciliation of the Late Enrollment Penalty Status (LEP), Hospice status, Special Needs status gender and date of birth discrepancies and Medicare Premium Withhold reports, and Low Income Subsidy.-Reviews and audits plan sponsor member listings, other payment documentation, and corresponding payment history and determine if any discrepancies exist; reconciles plan membership discrepancies to facilitate accurate data feeding to downstream systems. Provides "root cause" analysis and process improvement opportunities to the management team.-Demonstrates working knowledge of standard enrollment processes, election period hierarchy and membership reports for customer and/or plan; effectively uses them as a tool to drive improvements and enhance results.-Helps the management/audit team create, review and prepare for various audits. (SOX, EDV, CMS, Internal)Pay RangeThe typical pay range for this role is:Minimum: 17.00Maximum: 27.16Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required QualificationsA minimum of 1+ years professional work experience.Proficient in Microsoft Word, Access, PowerPoint, Excel, Teams and Outlook.COVID 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- Working knowledge of NextGen Systems. - Ability to analyze information and reports.- Ability to prioritize tasks/work effectively.- Strong verbal and written communication skills.- Problem solving skills/Attention to detail and accuracy.- Data entry experience.EducationHigh School/EquivalentBusiness 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: 2025-11-15