Customer Service Representative

2 days ago

🐊 Florida – Remote

Although this job is listed in Florida, this company may be open to hiring remote in other states.

🏈 Ohio – Remote

Although this job is listed in Ohio, this company may be open to hiring remote in other states.

+2 more states

🐊 Florida – Remote 🏈 Ohio – Remote 🔔 Pennsylvania – Remote 🤠 Texas – Remote

💵 $17 - $25 / hour

⏰ Full Time

🟢 Junior

💝 Customer Support

🚫👨‍🎓 No degree required

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CVS Health

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CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

Retail • Pharmacy Benefits Management • Health Insurance • Health Care • Pharmacy

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

📋 Description

• 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 • Customer inquiries are of basic and at times complex nature • 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 • The CSR 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 • Taking 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+ years of healthcare within a call center • Customer Service experience in a transaction based environment such as a call center location preferred, demonstrating ability to be empathetic and compassionate • Experience in a production environment • Prior experience providing customer service to the senior population, knowledge of medical terminology including Medicare and Medicaid policies • Must have high speed internet with consistent speeds above 25mbps and adherence to telework agreement

🏖️ Benefits

• 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.