Customer Service Representative, CVS Health

CVS Health

Location:
United States, Work At Home

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:

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
Guides the member through their members plan of benefits, Aetna policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines
Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health
Takes 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, 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
Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received

Requirements:

1 year of Customer service experience
Must reside in IL
Ability to multi-task to accomplish workload efficiently
Oral and written communication skills
Ability to maintain accuracy and production standards
Technical skills
Problem solving skills
Attention to detail and accuracy

Nice to have:

1 year of healthcare experience
1 year of call center experience

What we offer:

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and 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:
July 15, 2025

Expiration:
August 31, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Customer Service Representative