Customer Service Representative, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Customer Service

Contract Type:
Employment contract

Salary:

17.00 - 25.65 USD / Hour

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Job Description:

Customer Service Representative role at CVS Health's Center of Excellence Customer Service group, working remotely to handle customer inquiries and provide support for Aetna health plans, serving members through phone, internet, and written correspondence.

Job Responsibility:

Customer Service Representative is the face of Aetna and impacts members' service experience
Handles customer service inquiries and problems via telephone, internet or written correspondence
Engages, consults and educates members based upon the member's unique needs
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
Guides members through their plan of benefits and Aetna policy and procedures
Processes claim referrals, new claim handoffs, nurse reviews, complaints
Educates providers on self-service options
Assists providers with credentialing and re-credentialing issues
Responds to requests 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 and verifies member plan eligibility
Handles incoming requests for appeals and pre-authorizations
Performs review of member claim history
Performs financial data maintenance

Requirements:

1+ years of Customer Service experience in a transaction based environment such as a call center location preferred
Must have high speed internet with consistent speeds above 25mbps and adherence to telework agreement (wired in)
Must be willing to work Monday - Friday (8hr work day sometime within 8am-8pm in the time zone you live in)
High School diploma, G.E.D. or equivalent experience

Nice to have:

1+ years of Healthcare experience
Experience in a production environment
Prior experience providing customer service to the senior population
Knowledge of medical terminology including Medicare and Medicaid policies

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:
August 28, 2025

Expiration:
September 29, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Customer Service Representative