Customer Service Representative - Behavioral Health
About The Position
CVS Aetna is hiring a full-time Customer Service Representative aligned with the Behavioral Health team. The role provides advocate care by helping members find a clear path to care, understand and resolve claims, and learn about online resources. The representative guides members through benefit plans and Aetna policies and procedures, while maintaining knowledge of applicable regulatory guidelines. The position is suited to someone with strong interpersonal skills, an interest in mental wellness advocacy, and comfort using digital platforms in a fast-paced, emotionally sensitive setting. Training is Monday through Friday, 10:00 AM–6:30 PM EST, for eight weeks. After training, employees must be available to work within the 8:00 AM–8:00 PM EST window. The shift is assigned after an offer and may change at least once a year.
Requirements
- 1–3 years of call center and/or customer service experience.
- 1–3 years of healthcare and/or medical insurance experience.
- Basic computer knowledge and technical skills to use IP phones, customer records management systems, word processing, databases, and email/chat programs.
- A private, confidential workspace free from distractions.
- A hardwired connection, such as Ethernet.
- Time management skills to promptly respond to emails, calls, and chat messages.
- Active listening skills to effectively handle members who may be upset.
- High school diploma or equivalent.
Nice To Haves
- Background in mental health or human services.
- Bilingual or multilingual skills.
- Experience working remotely from home.
- Associate degree.
Responsibilities
- Take inbound member calls and determine effective ways to answer questions.
- Build an emotional connection with members by understanding and engaging them to champion their best health.
- Enter records within the overall member management system.
- Provide introductory information and connect members with appropriate additional benefits or external resources.
- Review members’ claim history to ensure accurate tracking of benefit maximums, including deductible and coinsurance levels.
- Explain members’ rights and responsibilities in accordance with plan sponsor contracts.
- Send outbound emails to members when needed.
- Troubleshoot and de-escalate member concerns when needed.
- Escalate queries and concerns when necessary.
- Handle complaints and inquiries to support member satisfaction with products and services.
- Share solutions and processes with the customer service team.
- Embody CVS Core values in each interaction.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
- Eligibility for a CVS Health bonus, commission, or short-term incentive program
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
