Senior Integrated Service Specialist

CVS Health•Work At Home-Arizona, SC

2d•$19 - $35

About The Position

The Senior Integrated Service Specialist serves as the primary point of contact for customers seeking assistance with claims-related inquiries. The role provides clear and accurate information about claims submissions, status updates, denial reasons, and payment or reimbursement issues. It also facilitates referrals to in-network healthcare providers and contributes to service improvement initiatives. Under limited supervision, the specialist completes routine and non-routine business support tasks for Integrated Services, following area protocols, standards, and policies. The role interfaces with clients and providers by telephone, fax, and email to identify and resolve member needs through analysis and evaluation of information and solutions. It researches and updates information in internal systems and resources to resolve enrollment and accounts receivable questions and process claims and adjustments. The specialist also manages client inquiries through work queues, monitoring and adjusting workflow to balance workloads, and takes direction in carrying out assigned techniques, processes, and responsibilities.

Requirements

At least 3 years of customer service experience.
2–3 years of claims processing experience.
2–3 years of client support experience.
Proficiency in Microsoft Word and Excel.
Analytical experience, including the ability to interpret data and make informed decisions.
High school diploma or GED.

Nice To Haves

Experience in a metric-based environment.

Responsibilities

Complete routine and non-routine business support tasks for the Integrated Services area under limited supervision, referring deviations from standard practices to managers.
Follow area protocols, standards, and policies to provide effective and timely support.
Communicate with clients and providers by telephone, fax, and email to identify and resolve member needs by analyzing and evaluating information and solutions.
Research and update information using internal systems and resources to resolve enrollment and accounts receivable questions and process claims and adjustments.
Manage work distribution for client inquiries through work queues, monitoring and adjusting workflow to balance workloads.
Carry out assigned techniques, processes, and responsibilities under direction.
Provide customers with information about claims submissions, status updates, denial reasons, and payment or reimbursement issues.
Facilitate referrals to in-network healthcare providers and contribute to service improvement initiatives.