Customer Service Representative (Arizona)

CVS Health•Work At Home-Arizona, AZ

5d•$17 - $31•Onsite

About The Position

Our Customer Service Representative is the face of Aetna/Mercy Care and impacts members' service experience by handling customer service inquiries and problems via telephone, internet, or written correspondence. For this role, customer inquiries are of basic and - at times - complex nature.

Requirements

At least 1 year of experience in a call center and/or high call-volume environment.
At least 1 year of experience in health insurance, particularly Medicaid, Medicare, and/or Medicare Advantage.
Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook).
Willingness to work a flexible schedule from Monday-Friday from 8am-6pm Arizona Time.

Nice To Haves

Demonstrated knowledge of medical terminology.
Previous experience in a healthcare environment.
Strong organizational and time management skills.
Excellent communication skills.
Ability to demonstrate empathy in a professional, customer-oriented manner.
Previous experience in Medicare.
Bilingual (English/Spanish).

Responsibilities

Engage, consult, and educate members, based upon the member’s unique needs, preferences, and understanding of Aetna plans, tools, and resources, in order to guide the members along a clear path to care.
Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors.
Triage any resulting rework to appropriate staff.
Document and track contacts with members, providers, and plan sponsors.
Guide members through benefits plan and Aetna policy & procedures, while maintaining knowledge of resources to comply with any regulatory guidelines.
Take accountability to fully understand members’ needs by building a trusting and caring relationship with them.
Anticipate customer needs.
Provide the customer with related information to answer various questions; e.g. additional plan details, benefit plan details, member self-service tools, etc.
Use customer service threshold framework to make financial decisions, in order to resolve member issues.
Explain members’ rights and responsibilities in accordance with contract.
Handle incoming requests for appeals and pre-authorizations, specifically those not handled by Clinical Claim Management.
Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
Perform other duties as needed.