Eligibility Consultant

Are you passionate about helping individuals access the healthcare coverage they need? Do you have a strong understanding of eligibility requirements and regulations? Aetna is seeking an experienced Eligibility Consultant to join our team and play a crucial role in ensuring our members receive the right coverage at the right time. In this role, you will have the opportunity to make a positive impact on people's lives by utilizing your expertise in eligibility determination. We are looking for a highly motivated and detail-oriented individual with excellent communication skills and a deep understanding of healthcare eligibility guidelines. If you are dedicated to providing exceptional customer service and have a drive to improve healthcare access, we want to hear from you.

1. Conduct eligibility assessments for members to determine their eligibility for healthcare coverage.
2. Review and interpret eligibility guidelines and regulations to ensure accurate and timely determination.
3. Communicate with members, providers, and internal teams to gather necessary information and resolve eligibility inquiries.
4. Maintain accurate and up-to-date records of eligibility determinations and related documentation.
5. Collaborate with other departments, such as claims and customer service, to ensure members receive the appropriate coverage.
6. Stay informed on changes in healthcare regulations and eligibility requirements to ensure compliance.
7. Provide excellent customer service by responding to inquiries and resolving issues in a timely and professional manner.
8. Participate in training and education programs to stay updated on eligibility guidelines and processes.
9. Work closely with team members to identify areas for process improvement and implement solutions.
10. Adhere to privacy and confidentiality policies when handling sensitive member information.
11. Meet productivity and quality standards set by the organization.
12. Serve as a subject matter expert on eligibility guidelines and processes within the organization.
13. Continuously strive to improve the efficiency and accuracy of eligibility determination processes.
14. Maintain positive relationships with members, providers, and internal teams to ensure a seamless experience.
15. Act as a resource for other team members and provide guidance and support when needed.
16. Assist with special projects and initiatives related to eligibility as assigned by the supervisor.

According to JobzMall, the average salary range for a Eligibility Consultant in East Lansing, MI, USA is $50,000-$70,000 per year. This can vary depending on the specific job responsibilities, experience, and qualifications of the individual.

Aetna Inc. is an American managed health care company that sells traditional and consumer directed health care insurance and related services, such as medical, pharmaceutical, dental, behavioral health, long-term care, and disability plans, primarily through employer-paid (fully or partly) insurance and benefit programs, and through Medicare. Since November 28, 2018, the company has been a subsidiary of CVS Health.