Customer Service Representative, New Business Operations

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

We are seeking a compassionate customer-obsessed Customer Service Representative to care for our customers. Our customers include members of our benefit plans employers that offer benefits doctors hospitals and other providers of this role you will create connections with our customers by helping with their benefits and claims to improve their health and well-being. You will be responsible for educating customers about their benefits and claims while resolving issues and directing them to helpful resources. This position requires adaptability and empathy as you will be handling a variety of inquiries and ensuring customer satisfaction through kind and respectful interactions.

As the face of our company you will care for our customers by researching issues documenting outcomes resolving inquiries and delivering a high level of customer satisfaction. Your ability to listen and respond to customer needs is crucial in inspiring trust and loyalty.

What you will do:

• 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 members 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 members 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 Aetnas 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.

Required Qualifications

• 3 days onsite Tuesday-Thursday in Franklin TN

• 1-3 years Customer Service experiences in a transaction based environment such as a call center or retail location preferred.

• Demonstrating ability to be empathetic and compassionate.

• Experience in a production environment.

Preferred Qualifications

• Proficient in Excel.

• SQL experience a plus

• Insurance Knowledge - Plus

Education

• High School Diploma

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.