Customer Service Representative, New Business Operations

CVS Health•Franklin, TN

9d•$17 - $28•Hybrid

About The Position

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 healthcare. In 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.

Requirements

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.

Nice To Haves

Proficient in Excel.
SQL experience a plus
Insurance Knowledge - Plus

Responsibilities

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.