Eligibility Analyst

CVS Health

Analyst handling healthcare eligibility and billing processes at CVS Health. Establishing compliance and providing guidance for client eligibility assessments and documentation for claims.

Posted 6/4/2026full-timeWork from Home • Texas • 🇺🇸 United StatesJuniorMid-Level💰 $43,888 - $85,068 per yearWebsite

About the role

Key responsibilities & impact

Establishes and maintains processes regarding billing and claims processing, insurance verification and authorization, revenue cycle management, compliance and documentation, as well as customer service and issue resolution.
Reconciles and solves issues to ensure accurate billing, facilitate smooth revenue flow, maintain compliance, and provide satisfactory customer experiences.
Reviews and analyzes applications, forms, and supporting documentation to verify individuals' eligibility for healthcare programs or insurance coverage.
Applies eligibility rules and regulations when evaluating information submitted by customers in support of initial or continuing eligibility determination.
Compiles and evaluates information, calculating eligibility factors, and ensuring consistent and fair eligibility determinations.
Escalates eligibility issues and updates member records in the appropriate database(s) to ensure accurate data.
Conducts basic quality audits of eligibility uploads to ensure data integrity is clean, accurate, and consistent with specifications.
Communicates regulations, rules, and policies to clients and apprises them of their rights, responsibilities, and eligibility for participation.
Educates customers on basic program services and eligibility requirements.
Coaches more junior colleagues in intellectual property techniques, processes, and responsibilities to help optimize eligibility reviews.
Assigns tasks, sets performance goals, conducts performance evaluations, and provides training and educational development opportunities to team members.

Requirements

What you’ll need

2+ years customer service or client-facing experience in a fast-paced environment
Basic awareness of problem solving and decision making skills.
Microsoft Office working experience.
3+ years in eligibility or other relevant background preferred.
Proficiency in processing accurate and timely Eligibility data.
Experience in EDI (Electronic Data Interchange).
Understanding of the PBM industry.
Experience in a healthcare client facing role.
Knowledge of ANSI X12 834 Data Documents.
Familiarity with RxClaim and/or AS400.
Microsoft Excel experience.

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

billing and claims processinginsurance verificationrevenue cycle managementeligibility determinationdata integrityproblem solvingdecision makingElectronic Data Interchange (EDI)ANSI X12 834 Data DocumentsRxClaim

Soft Skills

customer serviceissue resolutioncommunicationcoachingperformance evaluationtrainingeducational developmentanalytical skillsorganizational skillsteam leadership