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Eligibility Operations Advisor Jobs (NOW HIRING)

Managed Staffing

Pharmacist Operations Advisor

AL · Remote

$57 - $58/hr

Pharmacist Operations Advisor - Prior Authorization (Remote) Location: Remote (Excludes residents ... Verify insurance coverage, eligibility, and plan design applicability. * Collaborate with PA ...

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Eligibility Operations Advisor information

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$30.5K

$78.4K

$147K

How much do eligibility operations advisor jobs pay per year?

As of Jul 13, 2026, the average yearly pay for eligibility operations advisor in the United States is $78,414.00, according to ZipRecruiter salary data. Most workers in this role earn between $48,000.00 and $111,500.00 per year, depending on experience, location, and employer.

What are Eligibility Operations Advisors?

Eligibility Operations Advisors are professionals who oversee, manage, and support the processes related to determining eligibility for government programs, benefits, or insurance. They ensure that applications are processed accurately and efficiently, and that all regulatory guidelines are followed. These advisors may analyze cases, resolve complex eligibility issues, provide guidance to staff, and communicate with applicants to clarify requirements. Their work helps ensure fair and timely access to public assistance or benefits for those who qualify.

What are some common challenges faced by Eligibility Operations Advisors, and how can they be managed effectively?

Eligibility Operations Advisors often encounter challenges such as interpreting complex policies, managing high volumes of sensitive information, and balancing accuracy with efficiency in eligibility determinations. Successfully navigating these challenges requires strong attention to detail, effective time management, and clear communication with both team members and clients. Advisors can manage these demands by staying updated on policy changes, utilizing organizational tools, and seeking support from colleagues or supervisors when handling particularly complex cases.

What does an eligibility advisor do?

An eligibility operations advisor assesses and determines individuals' eligibility for specific programs or benefits by reviewing applications, verifying documentation, and ensuring compliance with policies. They often use specialized software and require strong attention to detail, communication skills, and knowledge of relevant regulations.

What's the easiest job to get hired at if you have social anxiety?

An Eligibility Operations Advisor role typically involves administrative tasks and communication with clients, often through email or phone. Jobs with minimal face-to-face interaction, such as data entry, remote customer support, or administrative roles, are generally more suitable for individuals with social anxiety. These positions often require organizational skills and may be performed remotely, reducing social stressors.

What is the difference between Eligibility Operations Advisor vs Eligibility Specialist?

CriteriaEligibility Operations AdvisorEligibility Specialist
Required CredentialsTypically requires a bachelor's degree in a related field; certifications like Certified Eligibility Specialist are commonUsually requires a high school diploma or associate degree; certifications may include eligibility or case management certifications
Work EnvironmentWorks in healthcare or government agencies, handling complex eligibility processes and policy interpretationWorks in similar settings, focusing on verifying eligibility and processing applications
Employer & Industry UsageUsed by healthcare providers, government programs, and insurance companiesCommonly employed in social services, Medicaid, and healthcare organizations

While both roles involve verifying eligibility, the Eligibility Operations Advisor typically handles more complex cases, policy interpretation, and process oversight, whereas the Eligibility Specialist focuses on processing applications and verifying basic eligibility criteria.

What jobs pay 4000 a week without a degree?

Eligibility Operations Advisor is typically a role that requires specific industry knowledge and experience rather than a high weekly salary without a degree. Generally, high-paying jobs that can reach $4,000 a week without a degree include skilled trades such as commercial driving, certain sales positions, real estate, or specialized technical roles that value experience and certifications over formal education. These roles often involve physical work, sales skills, or technical expertise and may require licensing or on-the-job training.

What skills do you need to be an eligibility specialist?

An Eligibility Operations Advisor needs strong analytical skills, attention to detail, and knowledge of eligibility criteria and regulations. Good communication skills and proficiency with data management tools or software are also important for verifying information and assisting clients efficiently.

What are the key skills and qualifications needed to thrive as an Eligibility Operations Advisor, and why are they important?

To thrive as an Eligibility Operations Advisor, you need strong analytical abilities, attention to detail, and a background in business administration or a related field. Familiarity with eligibility management systems, case management software, and knowledge of compliance regulations is typically required. Excellent communication, problem-solving, and organizational skills help advisors interact effectively with clients and coworkers while navigating complex eligibility criteria. These competencies are vital for ensuring accurate eligibility determinations, regulatory compliance, and efficient service delivery.
More about Eligibility Operations Advisor jobs
What job categories do people searching Eligibility Operations Advisor jobs look for? The top searched job categories for Eligibility Operations Advisor jobs are:
Eligibility Operations Advisor jobs near you
Infographic showing various Eligibility Operations Advisor job openings in the United States as of July 2026, with employment types broken down into 93% Full Time, 6% Part Time, and 1% Contract. Highlights an 72% Physical, 3% Hybrid, and 25% Remote job distribution, with an average salary of $78,414 per year, or $37.7 per hour.
Pharmacist Operations Advisor

Pharmacist Operations Advisor

Managed Staffing

AL • Remote

$57 - $58/hr

Contractor

Re-posted 11 days ago

Job description

Job Title: Pharmacist Operations Advisor – Prior Authorization (Remote)
Location: Remote (Excludes residents of New Mexico and Colorado)
Start Date: September 15, 2025
Duration: 5 months (09/15/2025 to 02/13/2026)
 

About the Role:

Seeking licensed Prior Authorization Pharmacists with PBM (Pharmacy Benefit Management) experience for a fully remote contract opportunity. The Pharmacist Operations Advisor will be responsible for performing clinical reviews of prior authorization requests and supporting care delivery across Commercial Prior Authorization Unit.

Work Schedule:

  • Training:

    • Dates: September 15, 2025 – October 31, 2025

    • Time: Monday to Friday, 8:00 AM – 4:30 PM CST

  • Post-Training Shift Options (based on business need):

    • Sunday–Thursday or Tuesday–Saturday

    • 10:30 AM – 7:00 PM CST

    • 11:00 AM – 7:30 PM CST

    • 11:30 AM – 8:00 PM CST

Please indicate preferred shift at the top of the resume.

Key Responsibilities:

  • Conduct clinical and criteria-based reviews of prior authorization requests.

  • Verify insurance coverage, eligibility, and plan design applicability.

  • Collaborate with PA technicians and other healthcare providers to ensure timely case resolution.

  • Handle inbound/outbound calls from physicians, healthcare providers, and members.

  • Ensure compliance with departmental protocols, approval/denial processes, and privacy guidelines.

  • Maintain up-to-date clinical and technical knowledge for CVS Specialty and Non-Specialty programs.

  • Participate in training, development sessions, and on-call coverage as needed.

Required Qualifications:

  • Active Registered Pharmacist License in the state of residence.

  • 1–3 years of experience working in a PBM and/or Prior Authorization setting (required).

  • Solid understanding of clinical guidelines and managed care principles.

  • Proficiency with Microsoft Office (Excel and Word; Access, Outlook, and Visio preferred).

  • Strong multitasking ability using multiple applications simultaneously.

  • Excellent written, verbal, and interpersonal communication skills.

  • Proven problem-solving and attention to detail.

  • Ability to work independently and maintain confidentiality of PHI.

Education Requirements:

  • Required: BS in Pharmacy + Active Pharmacist License

  • Preferred: Doctorate of Pharmacy (PharmD)