Customer Service Representative, CVS Health

CVS Health

Location:
United States, Work At Home, Arizona

Category:
Customer Service

Contract Type:
Not provided

Salary:

17.00 - 31.30 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:

Engage, consult, and educate members, based upon the member’s unique needs, preferences, and understanding of Aetna plans, tools, and resources, in order to guide the members along a clear path to care
Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors
Triage resulting rework to appropriate staff
Document and track contacts with members, providers, and plan sponsors
Guide members through benefits plan and Aetna policy & procedures, while maintaining knowledge of resources to comply with any regulatory guidelines
Take accountability to fully understand members’ needs by building a trusting and caring relationship with them
Anticipate customer needs
Provide the customer with related information to answer various questions
e.g. additional plan details, benefit plan details, member self-service tools, etc
Use customer service threshold framework to make financial decisions to resolve member issues
Explain members’ rights and responsibilities in accordance with contract
Handle incoming requests for appeals and pre-authorizations, specifically those not handled by Clinical Claim Management
Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible

Requirements:

At least 1 year of experience in a call center and/or high call-volume environment
Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook)
Ability to support Arizona Time Zone

Nice to have:

Demonstrated knowledge of medical terminology
Previous experience in a healthcare environment
Strong organizational and time management skills
Excellent communication skills
Ability to demonstrate empathy in a professional, customer-oriented manner

What we offer:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and 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:
August 19, 2025

Expiration:
August 29, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Customer Service Representative