Customer Service New Business Operations, CVS Health

CVS Health

Location:
United States, Franklin, TN

Category:
Customer Service

Contract Type:
Employment contract

Salary:

17.00 - 28.46 USD / Hour

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Job Description:

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues.

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
Taking accountability to fully understand the member's needs by building a trusting and caring relationship with the member
Anticipates customer needs
Provides the customer with related information to answer the unasked questions
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, grievance and appeals 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
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
Handles incoming requests for appeals and pre-authorizations
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

Requirements:

3 days onsite Tuesday-Thursday in Franklin, TN
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

Nice to have:

Proficient in Excel
SQL experience a plus
Insurance Knowledge - Plus

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation programs
Weight management programs
Confidential counseling
Financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
September 06, 2025

Expiration:
September 22, 2025

Employment Type:

Fulltime

Work Type:

Hybrid work

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Customer Service New Business Operations