Customer Service Team Lead, CVS Health

CVS Health

Location:
United States

Category:
Customer Service

Contract Type:
Not provided

Salary:

18.50 - 38.82 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:

Supports comprehensive coordination of medical services including intake, screening, and referrals
Promotes and supports quality effectiveness of Healthcare Services
Serves as a training resource, mentor, and subject matter expert

Requirements:

Performs intake of calls from members or providers regarding services via telephone, fax, or EDI
Contacts providers with authorization, denial, and appeals process information
handles difficult customer interactions
Utilizes appropriate system to build, research, and enter member information
Screens requests for appropriate referral to medical services staff
Approves services that do not require a medical review in accordance with the benefit plan
Performs non-medical research including eligibility verification, coordination of benefits, and benefits verification
Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements
Promotes communication, both internally and externally to enhance effectiveness of medical management services
Protects the confidentiality of member information and adheres to company policies regarding confidentiality
Gathers information needed for coordinators/case managers to determine continued authorization
Enters referrals for non-complex services including DME, physical therapy, inpatient and outpatient care, and special circumstance requests as defined by Utilization Management
Provides education and acts as a resource to primary care practices and specialty care providers
Supports the administration of the precertification process in compliance with various laws and regulations, URAQ and NCQA standards, where applicable, while adhering to company policy and procedures
Under the supervision of clinical staff, places outbound calls to providers to obtain clinical information for approval of medical authorizations
Assesses training needs within the team
serves as training resource, mentor, and coach to others
Acts independently and manages own activities with minimal supervision and direction
assists other team members
takes ownership for problem resolution
Demonstrates, advocates, and reinforces a positive team environment
Assists with the identification and reporting of potential quality management issues
responsible for assuring these issues are reported to the Quality Management Department
Performs other related duties as required

Nice to have:

Experience with Microsoft Office products (Word, Excel, Project, PowerPoint, Outlook)
Minimum of 3 years experience as an Inbound/Outbound Queue Associate
Demonstrates initiative and leadership in achieving results
Effective communication, telephonic and organization skills
Familiarity with basic medical terminology and concepts used in care management
Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members
Ability to effectively participate in a multi-disciplinary team including internal and external participants

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
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:
July 31, 2025

Expiration:
August 06, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Customer Service Team Lead