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The Claims and Customer Service Representative serves as the primary point of contact for customers seeking assistance with claims-related inquiries. This role is responsible for providing clear and accurate information regarding claims submissions, status updates, denial reasons, and payment or reimbursement issues. The representative also facilitates referrals to in-network healthcare providers and contributes to service improvement initiatives.
Job Responsibility:
Serve as primary point of contact for customers seeking assistance with claims-related inquiries
Provide clear and accurate information regarding claims submissions, status updates, denial reasons, and payment or reimbursement issues
Facilitate referrals to in-network healthcare providers
Contribute to service improvement initiatives
Requirements:
3 years of customer service experience required
2-3 years of claims processing experience
2-3 years of client support experience
Experience in a metric-based environment is a plus
Proficiency with Microsoft application (word, excel) is necessary
High School Diploma required
Minimum of three years of relevant experience
Nice to have:
Experience in a metric-based environment
What we offer:
Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
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
CVS Health bonus, commission or short-term incentive program
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