Eligibility Consultant in United States

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 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 electronic transfer of eligibility data. Responds, researches, and resolves eligibility and other enrollment related issues involving member specific information; works directly with clients, field marketing offices and/or local claim operations to achieve positive service outcomes. Applies all appropriate considerations associated with technical requirements, legislative/regulatory policies, account structure and benefit parameters in addressing eligibility matters. Develops tools, and provides coding supplements, tape specifications and error listing to clients/vendors. Acts as the liaison between clients, vendors, and the IT department with defining business requirements associated with non-standard reporting; identifies potential solutions and approves programming specifications required for testing any non-standard arrangements. Ensures all transactions interface accordingly with downstream systems; tests and validates data files for new or existing clients using system tools and tracks results to avoid

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. Registered Nurse must hold a CDCES- Certified Diabetes Care and Education Specialist This is a full-time telework role for a RN who resides in a compact state and holds a compact license. Working schedule: Monday-Friday, standard business hours, including 1 evening shift per week from 12:30- pm EST -The Health Coach Consultant utilizes a collaborative process of assessment, planning, implementation and evaluation, to engage, educate, and promote and influence member's decisions related to achieving and maintaining optimal health status for chronic conditions. - Assessment of members through the use of clinical tools and information/data review, conducts comprehensive evaluation of member's needs and benefit plan eligibility for available integrated internal and external programs/services. -Utilizes assessment techniques to determine member's level of health literacy, technology capabilities, and/or readiness to change. -Enhancement of Medical Appropriateness & Quality of Care: -Application and/or interpretation of applicable criteria and guidelines, health/wellness management plans, policies, procedures, regulatory standards while assessing benefits and/or member's needs to enable appropriate utilization of services and/or administration and integration with available internal/external programs. -Usi

Every day, tens of millions of people come to Roblox to explore, create, play, learn, and connect with friends in 3D immersive digital experiences– all created by our global community of developers and creators. At Roblox, we’re building the tools and platform that empower our community to bring any experience that they can imagine to life. Our vision is to reimagine the way people come together, from anywhere in the world, and on any device. We’re on a mission to connect a billion people with optimism and civility, and looking for amazing talent to help us get there. A career at Roblox means you’ll be working to shape the future of human interaction, solving unique technical challenges at scale, and helping to create safer, more civil shared experiences for everyone. As a Global Mobility Lead, you will report to the Global Mobility Manager who oversees Roblox’s worldwide immigration and relocation programs. As a member of Global Mobility team, this role will serve as a Subject Matter Expert for employees, managers, and internal stakeholders on complex immigration cases, implications, and relocation logistics. This role will ensure a seamless, compliant, and positive experience for employees and their families throughout their global mobility journey. You Will: Immigration Strategy & Compliance (Core Focus): Serve as Subject Matter expert on global immigration laws. Manage the full lifecycle of global work permit, visa, and residency applications, coordinating with external legal counsel. Conduct immigration assessments, determine eligibility, and identify risks. Ensure robust compliance, maintaining meticulous records and audit trails. Monitor regulatory changes and advise on impacts. Vendor Management & Collaboration: Manage relationships with global mobility service providers (immigration firms, relocation companies, tax consultants). Collaborate and advise HR Business Partners, Legal, Finance, and Payroll to ensure streamlined processes

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. If you're looking to make a global difference in your next role, this opportunity is for you. Aetna International is seeking an Analyst, Account Manager who is passionate about delivering an exceptional customer experience and supporting the ongoing success of our Access U.S. customers. In this role, you will partner with Account Managers, customers, brokers, and internal business partners to provide day-to-day operational and service support throughout the customer lifecycle. You will help drive customer satisfaction and membership retention through proactive coordination, accurate execution, consultative problem-solving, and timely issue resolution. The Access U.S. business provides comprehensive health benefit solutions for U.S.-based employees of multinational organizations. Through a range of medical plans, wellness programs, digital health tools, global support services, and dedicated account management, Access U.S. helps employers offer competitive benefits while providing members with access to high-quality care and a personalized health care experience. Position Summar y Supports the Account Management team in delivering a consistent, high-quality experience for Access U.S. customers, brokers, and members. Provides operational and administrative support across eligibility, enrollment, benefit documentation, customer service activities, and issue resolution. Collaborat

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 position is for a Clinical Pharmacist working in the Prior Authorization team. - Collaborates with the technicians and prior authorization team members to process referrals, including answering clinical questions and collecting appropriate clinical/medical data needed to perform clinical assessments and reviews as per the health plan/employer-agreed criteria within the designated service level agreements. - Evaluate and review all prior authorization requests and render coverage determinations based on clinical criteria and plan design. Includes verifying insurance coverage and eligibility, interpreting clinical guideline criteria, consulting physicians and other healthcare providers, and appropriately utilizing clinical knowledge and resources while complying with department protocols. - One of the crucial responsibilities is to guarantee that the decisions regarding cases are conveyed promptly and efficiently to all the healthcare providers, health plans/employers, patients, and other healthcare professionals following agreed-upon approval & denial management processes. - Performs and handles inbound and outbound phone calls with technicians, prior authorization team members, physicians, healthcare providers, and/or patients to facilitate prior authorization requests, answer inquiries, and/or resolve escalations. - Establishes and maintains communicat

The pay range per hour is $20.82 - $37.45. You may also earn additional compensation in the form of a shift differential, ranging from $2.00 to $3.50 per hour, based on eligibility. Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . About us: Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . Target Global Supply

The pay range per hour is $20.82 - $37.45. You may also earn additional compensation in the form of a shift differential, ranging from $2.00 to $3.50 per hour, based on eligibility. Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . About us: Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . Target Global Supply Chain and Logis

The pay range per hour is $20.82 - $37.45. You may also earn additional compensation in the form of a shift differential, ranging from $2.00 to $3.50 per hour, based on eligibility. Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . About us: Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . Target Global Supply Chain an

The pay range per hour is $32.40 - $35.40. You may also earn additional compensation in the form of a shift differential, ranging from $2.00 to $3.50 per hour, based on eligibility. Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . Available Shift: Saturday, Sunday, Monday from 5:00pm - 5:00am About us: Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. <a target="_blank" href="https://corporate.target.com/ab

The pay range per hour is $17.98 - $30.48. You may also earn additional compensation in the form of a shift differential, ranging from $2.00 to $3.50 per hour, based on eligibility. Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . Schedules: Saturday - Monday 7:00am-7:00pm Tuesday - Friday 4:00am - 2:00pm About us: Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. <a target="_blank" href="https:

Starting Hourly Rate $33.15 USD per hour. You may also earn additional compensation in the form of a shift differential, ranging from $2.00 to $3.50 per hour, based on eligibility. Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . About us: Working at Target means helping all families discover the joy of everyday life. We bring that vision to life through our values and culture. Learn more about Target here . A role in a Distribution Cen

The pay range per hour is $39.00 - $43.00. You may also earn additional compensation in the form of a shift differential, ranging from $2.00 to $3.50 per hour, based on eligibility. Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. Find competitive benefits from financial and education to well-being and beyond at https://corporate.target.com/careers/benefits . About the Job: Shift: A2: Saturday - Monday from 6PM to 6AM Tuition-Free Program Health Benefits After 14 Days of Employment About us: Working at Target means helping all fami

The pay range per hour is $27.00-28.00. You may also earn additional compensation in the form of a shift differential, ranging from $2.00 to $3.50 per hour, based on eligibility. Pay is based on several factors which vary based on position. These include labor markets and in some instances may include education, work experience and certifications. In addition to your pay, Target cares about and invests in you as a team member, so that you can take care of yourself and your family. Target offers eligible team members and their dependents comprehensive health benefits and programs, which may include medical, vision, dental, life insurance and more, to help you and your family take care of your whole selves. Other benefits for eligible team members include 401(k), employee discount, short term disability, long term disability, paid sick leave, paid national holidays, and paid vacation. ALL ABOUT TARGET As a Fortune 50 company with more than 400,000 team members worldwide, Target is an iconic brand and one of America's leading retailers. Working at Target means the opportunity to help all families discover the joy of everyday life. Caring for our communities is woven into who we are, and we invest in the places we collectively live, work, and play. We prioritize relationships, fuel and develop talent by creating growth opportunities, and succeed as one Target team. At our core, our purpose is ingrained in who we are, what we value, and how we work. It’s how we care, grow, and win together. ALL ABOUT OUR SUPPLY CHAIN OPERATIONS INTERNSHIP Experience firsthand what it’s like to lead a team within a Target Supply Chain Facility. This internship is a paid 40 hr./week, hands-on training program to develop and prepare for your operations leadership. As an Operations Intern,</s

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 position is open to candidates located in Arizona. The work schedule is Monday through Friday, from 8:30 AM to 5:00 PM Arizona time. The Care Management Associate (CMA) supports comprehensive coordination of medical services that include intake and outgoing calls for medical services. We work closely with both case management team and utilization management team. The Care Management Associate will review eligibility and benefits and open pre-certification cases and either approve or send to nursing staff for review. Additional responsibilities include but not limited to the following: - Evaluates patients using targeted intervention business rules and processes to identify needed medical services, make appropriate referrals to medical services staff, and coordinate the required services by the benefit plan. - Communicates health care service delivery as required based on outcomes/reviews noted by the nurse or medical director - Performs non-medical research pertinent to the establishment, maintenance, and closure of open cases. - Provides support services to team members by answering telephone calls from providers and members, taking accurate messages, supporting electronic transmission review and referrals as appropria

Become a part of our caring community The Care Management Support Assistant contributes to administration of care management. Provides non-clinical support to the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Management Support Assistant performs basic administrative/clerical/operational/customer support/computational tasks. Typically works on routine and patterned assignments. The Care Management Support Assistant will review inbound referrals and correspondence for processing, fulfilment or resolution utilizing all appropriate software systems and resources. Screen physician’s orders and documentation to identify that all qualifying medical documentation and required information is included. When necessary, request additional applicable information from referring entity. Perform verification of benefits coverage and eligibility for services per Health Plan contract. Review referral data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures for approving request or referring request for further review. Provide referral management education to members and providers regarding medical benefits, referral status and prior authorizations. Communicate with patient to confirm demographics and explain the details of the services/care requested. Coordinate the timely delivery of care and services with providers. Also communicate with referring entities, providers, and members regarding final referral determination while maintaining detailed documentation to record patient, physician, referral source and provider interactions and communications. Work with Pre-Authorization, Utilization Management, Billing, Pharmacy, and Home Care r