SC Works IT Jobs

Job Information

CVS Health Sr Eligibility Consultant in Columbia, South Carolina


Job Description:

Processes accurate and timely policy and eligibility data utilizing administration systems for claim payment purposes and product production (e.g., ID cards, billings, mailings, etc.). Ensures services and products meet the plan sponsor’s needs.



Job Group:

Customer Service

Full or Part Time:

Full Time

Supervisory Responsibilities:


Percent of Travel Required:

0 - 10%

Posting Job Title:

Senior Eligibility Consultant

Potential Telework Position:


Additional Locations:


Primary Location (City, State):


EEO Statement:

Aetna is an Equal Opportunity, Affirmative Action Employer

Resource Group:


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.

Fundamental Components:

  • Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements.

  • Delivers consulting services in support of data discrepancies and/or involving reporting alternatives.

  • Responds to eligibility and other enrollment related issues involving member specific information; partners directly with clients, vendors, field marketing staff, and/or local claim operation to resolve problems and achieve positive outcomes.

  • Assists with and/or evaluates recommendations involving electronic eligibility reporting solutions and negotiates with internal/external clients.

  • Validates member information for accuracy and coordinates the distribution of member ID cards; consults with internal/external clients concerning ID customization.

  • Determines and communicates standard service charges to internal/external customers related to electronic eligibility activities; may negotiate and communicate charges pertaining to non-standard services.

  • Completes screen coding and data entry requirements supporting the system processes impacting the generation and release of member-specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists, HIPAA certificates, repots, etc.).

  • Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters.

  • Designs, develops, and delivers transitional training processes and procedures to smooth the transition for newly hired employees from formalized classroom training to the department’s production environment; may also mentor newly-hired employees.

  • Coaches, develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors.

Background Experience:

  • Electronic eligibility experience is required

  • College degree or equivalent experience

Benefits Program:

Benefit eligibility may vary by position.

Candidate Privacy Information:

Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

Clinical Licensure Required: