Customer Service Representative-Hybrid Franklin, TN.

Were building a world of health around every individual shaping a more connected convenient and compassionate health experience. At CVS Health youll be surrounded by passionate colleagues who care deeply innovate with purpose hold ourselvesaccountable and prioritize safety and quality in everything we do. Join us and be part of something bigger helping to simplify health care one person one family and one community at a time.

Position Summary

The Call Center Representative serves as the primary point of contact for members providers and plan sponsors delivering exceptional customer service through phone digital and written communication channels. This role is responsible for resolving inquiries educating customers on benefits and available resources advocating for customer needs and creating positive service experiences. The representative demonstrates strong problem-solving skills professionalism empathy and accountability while ensuring compliance with company policies and regulatory requirements.

This position operates on a hybrid work schedule combining remote and in-office work. The representative must effectively manage responsibilities in both environments maintain productivity and service standards and adhere to all company policies related to attendance security and customer confidentiality.

Key Responsibilities

• Respond to member provider and plan sponsor inquiries through telephone chat email and written correspondence.
• Resolve routine and complex customer concerns while delivering a high-quality customer experience.
• Accurately document customer interactions and maintain detailed records in applicable systems.
• Educate customers on plan benefits policies procedures and self-service tools.
• Identify customer needs through active listening and provide personalized solutions and recommendations.
• Research and resolve claims eligibility billing enrollment and benefit-related issues.
• Coordinate escalations and referrals to appropriate departments when necessary.
• Demonstrate ownership of customer concerns through first-call resolution whenever possible.
• Maintain productivity quality compliance and customer satisfaction standards.
• Support appeals grievances complaints and authorization-related inquiries according to established guidelines.
• Utilize multiple systems and resources to investigate issues and provide accurate information.
• Adhere to HIPAA regulatory requirements and company policies regarding privacy and confidentiality.
• Participate in training coaching and continuous improvement initiatives.
• Contribute to a positive team environment by sharing knowledge and supporting organizational goals.

Required Qualifications

• Minimum one year of customer service call center healthcare insurance or related experience preferred.
• Able to work a Hybrid schedule 3 days a week.
• Ability to navigate multiple systems while speaking with customers.
• Demonstrated problem-solving critical thinking and decision-making abilities.
• Ability to manage competing priorities in a fast-paced environment.
• Proficiency with Microsoft Office and customer relationship management systems.

Preferred Qualifications

• Experience in healthcare insurance or benefits administration.
• Knowledge of claims eligibility appeals and authorization processes.
• Experience supporting customers through multiple communication channels including phone chat and email.
• Strong verbal and written communication skills.
• Strong attention to detail and organizational skills.
• Bilingual skills preferred where applicable.

Education

• High school diploma or GED equivalent

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience education geography and other relevant factors.

Our people fuel our future. Our teams reflect the customers patients members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws.