Customer Service Representative – Remote

Job Responsibilities : Customer Service Representative – Remote Salary : $15 per hour Company : CVS Health Location : Remote US Educational requirements : High School

Answers questions and resolves issues based on phone calls/letters from members providers and plan sponsors. Triages resulting rework to appropriate staff. Documents and tracks contacts with members providers and plan sponsors. The CSR guides the member through their members plan of benefits Aetna policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines. 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.

Background/Experience desired :Edit the standard text below to make it fit your current opening(s). Re-write it keeping in mind that this will be used by Recruiting to screen candidates and by candidates to decide if they should apply. Keep this section short. Use the reference material below for suggestions. :
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

Required Qualifications

COVID Requirements
COVID-19 Vaccination Requirement
CVS Health requires its Colleagues in certain positions to be fully vaccinated against COVID-19 (including any booster shots if required) where allowable under the law unless they are approved for a reasonable accommodation based on disability medical condition pregnancy or religious belief that prevents them from being vaccinated.

  • If you are vaccinated you are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status within the first 30 days of your employment. For the two COVID-19 shot regimen you will be required to provide proof of your second COVID-19 shot within the first 60 days of your employment. Failure to provide timely proof of your COVID-19 vaccination status will result in the termination of your employment with CVS Health.
  • If you are unable to be fully vaccinated due to disability medical condition pregnancy or religious belief you will be required to apply for a reasonable accommodation within the first 30 days of your employment in order to remain employed with CVS Health. As a part of this process you will be required to provide information or documentation about the reason you cannot be vaccinated. If your request for an accommodation is not approved then your employment may be terminated.

Preferred Qualifications
call center or claims experience

High School or GED equivalent

Business Overview
At Aetna a CVS Health company we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible easier to use less expensive and patient-focused. Working together and organizing around the individual we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting hiring or promotion based on race ethnicity gender gender identity age disability or protected veteran status. We proudly support and encourage people with military experience (active veterans reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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