Senior Eligibility Specialist

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

Time Type

Pay Range

The typical pay range for this role is:

This 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.

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.