Customer Service Representative, CVS Health

CVS Health

Location:
United States, Work At Home, Ohio

Category:
Customer Service

Contract Type:
Employment contract

Salary:

17.00 - 25.65 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 – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

Customer Service Representative is the face of Aetna and impacts members' service experience by manner of how customer service inquiries and problems via telephone, internet or written correspondence are handled
Engages, consults and educates members based upon the member’s unique needs, preferences and understanding of Aetna plans, tools and resources to help guide the members along a clear path to care
Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors
Documents and tracks contacts with members, providers and plan sponsors
Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health
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

Requirements:

1+ years of healthcare within a call center
Customer Service experience in a transaction based environment such as a call center location preferred, demonstrating ability to be empathetic and compassionate
Experience in a production environment
Prior experience providing customer service to the senior population, knowledge of medical terminology including Medicare and Medicaid policies
Must have high speed internet with consistent speeds above 25mbps and adherence to telework agreement

What we offer:

Affordable medical plan options
a 401(k) plan (including matching company contributions)
an employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility

Additional Information:

Job Posted:
April 27, 2025

Expiration:
May 11, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Customer Service Representative

CVS Health

Location:United States, Work At Home, Ohio

Category:Customer Service

Contract Type:Employment contract