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Customer Service New Business Operations

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States , Franklin

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Category:
Customer Service

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Contract Type:
Employment contract

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Salary:

17.00 - 28.46 USD / Hour
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Job Description:

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.

Job Responsibility:

  • Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health
  • Anticipates customer needs
  • Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc
  • Uses customer service threshold framework to make financial decisions to resolve member issues
  • Explains member's rights and responsibilities in accordance with contract
  • Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system
  • Educates providers on our self-service options
  • Assists providers with credentialing and re-credentialing issues
  • Responds to requests received from Aetna's Law Document Center regarding litigation
  • lawsuits Handles extensive file review requests
  • Assists in preparation of complaint trend reports
  • Assists in compiling claim data for customer audits
  • Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals
  • Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management
  • Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible
  • Performs financial data maintenance as necessary
  • Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received

Requirements:

  • 1-3 years Customer Service experiences in a transaction based environment such as a call center or retail location preferred
  • Demonstrating ability to be empathetic and compassionate
  • Experience in a production environment
  • High School Diploma or equivalent GED

Nice to have:

  • Proficient in Excel
  • SQL experience a plus
  • Insurance Knowledge - Plus
What we offer:
  • medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs

Additional Information:

Job Posted:
May 15, 2026

Expiration:
May 26, 2026

Employment Type:
Fulltime
Work Type:
Hybrid work
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