Experienced Customer Service Representative - Work From Home - Claims Inquiry and Research Team at CVS Health

Transforming Healthcare, One Conversation at a Time At CVS Health, we're on a mission to bring our heart to every moment of your health. Our purpose is clear: to deliver enhanced human-centric health care that's personal, convenient, and affordable. As a Customer Service Representative on our Claims Inquiry and Research Team, you'll play a vital role in achieving this goal. You'll be the face of CVS Health, providing top-notch support to our members, providers, and plan sponsors. If you're passionate about delivering exceptional customer service and are looking for a remote work opportunity, we want to hear from you! About Our Company Culture At CVS Health, we're committed to creating a culture that's as caring as it is innovative. Our Heart At Work Behaviors guide our actions and decisions, ensuring that we're always putting our customers first. We believe in empowering our colleagues to make a difference in the lives of our customers and in their own careers. As a Customer Service Representative, you'll be part of a dynamic team that's dedicated to transforming the healthcare landscape. Key Responsibilities Respond to phone calls and letters from members, providers, and plan sponsors, resolving issues and answering questions in a timely and professional manner. Conduct extensive claims research on multiple platforms to assist providers with payment questions and concerns. Provide excellent customer service, ensuring that our customers receive the support they need to navigate our complex healthcare system. Use our customer service threshold framework to make financial decisions that resolve member issues efficiently and effectively. Process claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals via our target system. Educate providers on our self-service options, assisting them with credentialing, re-credentialing, and contracting questions and issues. Assist in compiling claim data for customer audits, determining medical necessity, applicable coverage provisions, and verifying member plan eligibility. Essential Qualifications High school diploma or GED equivalent required. Experience in a highly transactional call center environment, preferably in the healthcare or insurance industry. Excellent customer service and critical thinking skills, with the ability to resolve complex issues in a fast-paced environment. Familiarity with Microsoft Office products, including Word, Excel, and Outlook. Availability to work between 7am-7pm CST, Monday-Friday, with a commitment to attending 7 weeks of virtual training with no absences. High-speed internet access (25 mbps or higher) and a consistent connection, with a direct connection to the router (not Wi-Fi). Preferred Qualifications Previous experience in a healthcare or insurance setting, with a strong understanding of claims processing and customer service principles. Excellent communication and interpersonal skills, with the ability to work effectively with diverse stakeholders. Strong analytical and problem-solving skills, with the ability to navigate complex systems and processes. Skills and Competencies To succeed in this role, you'll need to possess a range of skills and competencies, including: Excellent customer service skills, with a strong focus on resolving issues and exceeding customer expectations. Strong communication and interpersonal skills, with the ability to work effectively with diverse stakeholders. Analytical and problem-solving skills, with the ability to navigate complex systems and processes. Ability to work in a fast-paced environment, with a strong attention to detail and a commitment to accuracy. Proficiency in Microsoft Office products, including Word, Excel, and Outlook. Career Growth Opportunities At CVS Health, we're committed to helping our colleagues grow and develop in their careers. As a Customer Service Representative, you'll have access to a range of training and development opportunities, including: Comprehensive onboarding program, with 7 weeks of virtual training to ensure you're equipped to succeed in your role. Ongoing coaching and feedback, with regular check-ins with your manager to discuss your progress and goals. Opportunities for career advancement, with a clear path for progression within the organization. Work Environment and Company Culture As a remote worker, you'll be able to work from the comfort of your own home, with the flexibility to create a work environment that suits your needs. We're committed to providing a supportive and inclusive culture, with a range of benefits and perks to support your well-being and success. Compensation and Benefits We offer a competitive compensation package, with a pay range of $17.00 - $25.65 per hour, depending on your experience and qualifications. In addition to your salary, you'll have access to a range of benefits, including: Medical, dental, and vision benefits, with a range of plan options to suit your needs. 401(k) retirement savings plan, with a company match to help you save for your future. Employee Stock Purchase Plan, allowing you to purchase CVS Health stock at a discounted rate. Paid Time Off (PTO) and vacation pay, with a range of holidays throughout the year. Well-being programs, education assistance, and free development courses to support your growth and development. Join Our Team! If you're passionate about delivering exceptional customer service and are looking for a remote work opportunity, we want to hear from you! As a Customer Service Representative on our Claims Inquiry and Research Team, you'll play a vital role in transforming the healthcare landscape. Apply now to join our dynamic team and start making a difference in the lives of our customers. Don't miss this opportunity to join a company that's committed to putting our heart into every moment of your health. Apply today and take the first step towards a rewarding and challenging career at CVS Health! Apply for this job