Eligibility Consultant - Paper-OPS

Company: Aetna Inc.
Location: Albany
Posted on: January 15, 2022

Job Description:

Job Description

Under general supervision, verifies enrollment status, makes changes to member/client records, and addresses a variety of enrollment questions or concerns.

Maintains enrollment databases and coordinates transfer of nonelectronic eligibility data.

Responds, researches, and resolves eligibility and/or billing related issues involving member specific information; works directly with clients, field

marketing offices and/or local claim operations to achieve positive service outcomes.

Monitors daily status reports assessing output for developing trends potentially impacting service levels.

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

Validates benefit plan enrollment information for assigned clients for accuracy and completeness and partners with appropriate internal/external support areas involving requests for ID cards.

Completes screen coding and data entry requirements related to the systems processes impacting the generation and release of member specific and plan sponsor products (e.g., ID cards, change applications, audit lists, in-force lists and various reports).

Completes data entry requirements for finalizing new enrollment information as well as for changes and/or terminations.

When necessary, reviews and corrects transaction errors impacting eligibility interfaces and saves eligibility/enrollment information into FileNet.

Interprets and translates client benefits and supporting account structure against internal systems/applications (i.e., MEA and CCI).

Determines and communicates standard service charges to internal/external customers related to paper eligibility activities; May include negotiating and communicating charges pertaining to non-standard services. Partners with other team functions to coordinate the release of eligibility and benefit plan information; reproduces group bills if requested by clients.

Required Qualifications

* 1+ Year experience in a high production environment.
* 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.
* Strong organization skills.
* Problem solving skills.
* Attention to detail and accuracy.

COVID Requirements

CVS Health requires its 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, or religious belief that prevents them from being vaccinated.

If you are 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 within the first 10 days of your employment. For the two COVID-19 shot regimen, you will be required to provide proof of your second COVID-19 shot within the first 45 days of your employment. In some states and roles, you may be required to provide proof of full vaccination before you can begin to actively work. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.

If you are unable to be fully vaccinated due to disability, medical condition, or religious belief, you will be required to apply for a reasonable accommodation within the first 10 days of your employment in order to remain employed with CVS Health. As a part of this process, you will be required to provide information or documentation about the reason you cannot be vaccinated. In some states and roles, you may be required to have an approved reasonable accommodation before you can begin to actively work. If your request for an accommodation is not approved, then your employment may be terminated.

Preferred Qualifications

* 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.
* Strong organization skills.
* Problem solving skills.
* Attention to detail and accuracy.

Education

* High School Diploma/Equivalency.

Business Overview

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.

Keywords: Aetna Inc., Albany , Eligibility Consultant - Paper-OPS, Professions , Albany, New York