Medicaid Provider 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:

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:

Answer questions and resolves issues based on phone calls/letters from providers
Triage resulting rework to appropriate staff
Provide excellent customer services for high volume inbound provider calls for the Claims Inquiry/Claims Research Medicaid team
Extensive claims research on multiple platforms to assist providers with payment questions
Educate provider with related information to answer the unasked questions
Use customer service threshold framework to make financial decisions to resolve provider issues
Explain provider's rights and responsibilities in accordance with contract
Process claim referrals, new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system
Assists providers with credentialing/re-credentialing and contracting questions and issues
Assist in compiling claim data for audits
Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals

Requirements:

Familiarity with Microsoft Office products such as OneNote, Outlook, Word, Teams, Excel
Ability to maneuver through multiple system applications to gather information while on a call
Excellent customer service and critical thinking is a must
Must secure high speed internet access (100 mbps or higher) with consistent, stable connection
Work location must be set up with a direct connection to the router (NOT Wi-Fi)
Private workspace that is secure, quiet, and uninterrupted, and that allows appropriate maintenance of confidentiality as required by HIPAA and CVS Health guidelines

Nice to have:

Healthcare background
Experience in highly transactional call center environment

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:
August 14, 2025

Expiration:
October 03, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Medicaid Provider Customer Service Representative