Experienced Customer Service Representative – Delivering Personalized Healthcare Solutions with Compassion and Empathy

Introduction to CVS Health At CVS Health, we are driven by a singular purpose: to bring our heart to every moment of your health. This guiding principle is at the core of our commitment to delivering enhanced, human-centric healthcare in a rapidly changing world. Our brand, with heart at its center, sends a personal message that how we deliver our services is just as important as what we deliver. We are seeking a dedicated and compassionate Customer Service Representative to join our team, embodying our Heart At Work Behaviors and contributing to transforming our culture and accelerating innovation in healthcare. Job Overview As a Customer Service Representative, you will be the face of Aetna, directly impacting members' service experience through handling customer service inquiries and problems via telephone, internet, or written correspondence. Your role will involve engaging, consulting, and educating members based on their unique needs, preferences, and understanding of Aetna plans, tools, and resources. You will guide members along a clear path to care, addressing basic and complex inquiries with empathy and professionalism. Key Responsibilities Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors. Triage resulting rework to appropriate staff and document and track contacts with members, providers, and plan sponsors. Guide members through their plan of benefits, Aetna policy and procedures, and knowledge of resources to comply with regulatory guidelines. Create an emotional connection with members by understanding and engaging them to the fullest, championing their best health. Take accountability to fully understand members' needs by building trusting and caring relationships. Anticipate customer needs and provide related information to answer unasked questions. Use the customer service threshold framework to make financial decisions to resolve member issues. Explain members' rights and responsibilities in accordance with contracts. Process claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals via the target system. Educate providers on self-service options and assist with credentialing and re-credentialing issues. Respond to requests from Aetna's Law Document Center regarding litigation and lawsuits, and handle extensive file review requests. Assist in preparing complaint trend reports and compiling claim data for customer audits. Determine medical necessity, applicable coverage provisions, and verify member plan eligibility relating to incoming correspondence and internal referrals. Handle incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Perform reviews of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Perform financial data maintenance as necessary and use applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries. Essential and Preferred Qualifications To excel in this role, you should possess: Customer Service Experience: Preferred experience in a transaction-based environment such as a call center or retail location, demonstrating empathy and compassion. Multi-Tasking Ability: Ability to multi-task to accomplish workload efficiently. Medical Terminology: Understanding of medical terminology. Communication Skills: Proficient oral and written communication skills. Technical Skills: Proficient with Microsoft Word and Outlook. Problem-Solving Skills: Strong problem-solving skills, with the ability to negotiate and analyze situations effectively. Attention to Detail: Attention to detail and accuracy, with analytical skills to ensure high-quality service delivery. Education: High School or GED equivalent. Career Growth Opportunities and Learning Benefits At CVS Health, we are committed to the growth and development of our employees. As a Customer Service Representative, you will have access to numerous training programs, education assistance, and free development courses to enhance your skills and knowledge. Our organization offers a supportive environment where you can build a long-term career, with opportunities for advancement and professional growth. Work Environment and Company Culture Our company culture is built on the principles of empathy, compassion, and innovation. We strive to create a work environment that is inclusive, supportive, and stimulating, where every employee feels valued and empowered to contribute their best. As a Customer Service Representative, you will be part of a dynamic team that is passionate about delivering exceptional service and making a positive impact on the lives of our members. Compensation, Perks, and Benefits We offer a competitive pay range of $17.00 - $29.88 per hour, depending on experience and location. In addition to your compensation, you will enjoy a comprehensive benefits package, including medical, dental, and vision benefits, a 401(k) retirement savings plan, an Employee Stock Purchase Plan, and numerous well-being programs. Our employees also receive paid time off, holidays, and discounts on CVS products and services. Conclusion If you are a compassionate and dedicated individual who is passionate about delivering exceptional customer service, we encourage you to apply for this exciting opportunity. As a Customer Service Representative at CVS Health, you will have the chance to make a real difference in the lives of our members, while growing your career and developing your skills in a supportive and innovative environment. Don't miss this chance to join our team and embark on a rewarding journey in healthcare. Apply now and take the first step towards a fulfilling career with CVS Health! Apply for this job