We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
This role is a senior individual contributor on the Eligibility team, responsible for accurate, timely eligibility processing and resolution of complex enrollment and eligibility issues. Senior Eligibility Consultants operate with increasing independence, manage a high volume of work across shifting priorities, and partner with internal teams, clients, and vendors to drive clear, high-quality outcomes. You’ll also support team capability by mentoring newer colleagues and helping bridge formal training into day-to-day production work.
In this role as a Senior Eligibility Consultant, you will:
Process policy and eligibility data accurately and on time using administration systems to support claim payment and plan sponsor service expectations
Resolve complex eligibility and enrollment issues by investigating discrepancies, identifying root causes, and driving issues to closure
Partner with internal teams, clients, and vendors to coordinate information, remove blockers, and achieve positive outcomes
Anticipate potential issues and take action early to prevent rework, delays, or downstream impacts
Contribute to process improvements that strengthen accuracy, efficiency, and consistency across workflows
Support reporting and data discrepancy work by helping evaluate options, documenting trade-offs, and recommending workable paths forward
Design and deliver transition support for newly hired colleagues as they move from classroom learning into the production environment
Coach and mentor junior team members through side-by-side support, feedback, and knowledge sharing
Manage multiple tasks and shifting priorities while maintaining quality and attention to detail
Contribute as a strong team player who can operate independently when needed
Required Qualifications
2+ years experience industry knowledge and enrollment/eligibility processing experience
Demonstrated comfort with professional email communication, including clear documentation, timely updates, and appropriate tone with internal and external partners
Ability to manage multiple incoming workflows and shifting priorities while staying organized and responsive
Experience supporting internal reporting requirements, including tracking work status, documenting outcomes, and meeting reporting deadlines
Proven ability to meet required turnaround times while maintaining strong accuracy and quality standards
Experience coaching, mentoring, or onboarding others in a production environment
Preferred Qualifications
Direct experience supporting COBRA and/or Eligibility programs, including familiarity with downstream impacts to claims and member experience
Experience handling escalated or exception-based eligibility cases (conflicting inputs, unclear data, complex retroactivity)
Experience identifying root causes of recurring issues and driving small process improvements that reduce rework
Experience supporting transitions (new clients, new processes, or system changes) and helping others ramp successfully
Experience creating or improving job aids, reference guides, or training materials for team use
Education
High School diploma, G.E.D. or equivalent experience.
Anticipated Weekly Hours
40Time Type
Full timePay Range
The typical pay range for this role is:
$18.50 - $38.82This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.
Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Great benefits for great people
We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
Job details are sourced from the employer's original posting.
Open job postingAbout the company
Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. Excellent benefits package, including 401k, tuition, licensure and certification reimbursement. We promote healthy & wellness lifestyles and offer specialty programs here at Aetna. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.