Integrated Service Senior Specialist

CVS Health•Work At Home-Arizona, AZ

2d•$19 - $35

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary The Senior Integrated Service Specialist serves as the primary point of contact for customers seeking assistance with claims-related inquiries. This role is responsible for providing clear and accurate information regarding claims submissions, status updates, denial reasons, and payment or reimbursement issues. The specialist also facilitates referrals to in-network healthcare providers and contributes to service improvement initiatives.

Requirements

3 years of customer service experience required.
2-3 years of claims processing experience.
2-3 years of client support experience.
Proficiency in Microsoft Word and Excel is required; analytical experience with the ability to interpret data and make informed decisions is essential.

Nice To Haves

Experience in a metric-based environment is a plus

Responsibilities

Executes both routine and non-routine business support tasks for the Integrated Services area under limited supervision, referring deviations from standard practices to managers.
Follows area protocols, standards, and policies to provide effective and timely support.
Interfaces with clients and providers via telephone, fax, electronic mail to identify and resolve member needs through analysis and evaluation of information and solutions.
Researches and updates information using internal systems and resources to resolve enrollment and accounts receivable questions and to process claims and adjustments.
Manages work distribution including client inquiries via work queues, monitoring, and adjusting workflow accordingly for load balance purposes.
Takes direction to execute techniques, processes, and responsibilities.