Customer Service Representative, CVS Health

CVS Health

Location:
United States, Ohio

Category:
Customer Service

Contract Type:
Employment contract

Salary:

17.00 - 25.65 USD / Hour

Save Job

Apply Position

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. This role, Customer Service Representative, involves assisting Aetna members, solving issues, consulting members about their plans, and creating emotional connections with customers for excellent service. The position is fully remote within CST or EST time zones.

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
Triages resulting rework to appropriate staff
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
Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member
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
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 Customer Service
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-6pm in the time zone you live in). All training and working hours will be remote, work from home.

Nice to have:

Healthcare experience
Customer Service experience in a transaction based environment such as a call center location
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 including matching company contributions
Employee stock purchase plan
No-cost wellness programs
Wellness screenings
Tobacco cessation and 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:
May 04, 2025

Expiration:
May 11, 2025

Employment Type:

Fulltime

Work Type:

Remote work

View All Jobs In This Company

Job Link Share:

Customer Service Representative