Job Description
We are looking for high-performing individuals to join our team. These members will be the line of communication and support for customers, helping them as they navigate their Health and Well-being journey. Join a team that’s changing the way people interact with their health for a better tomorrow.
This is a work-at-home opportunity for candidates located in the Pacific/Mountain time zone and Eastern time zone. This position also includes a $1000 sign-on bonus as well as an additional $2000 180 days after your start date! The sign-on and retention bonuses are not applicable to current internal employees of CVS or Aetna. (Bonuses are only applicable to specific positions, locations, and business groups. Applicable roles have the bonus language in the job posting.) • Customer Service Representative is the face of Aetna and impacts members’ service experience by the manner in which customer service inquiries and problems via telephone, internet, or written correspondence are handled. • Customer inquiries are of basic and at times complex nature. • Engages, consults and educates members based on the member’s unique needs, preferences, and understanding of Aetna plans, tools, and resources to help guide the members along a clear path to care. • Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. • Triages resulting in rework to appropriate staff. • Documents and tracks contacts with members, providers and plan sponsors. • The CSR guides the member through their member's 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 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 members’ rights and responsibilities in accordance with the contract. • Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievances,s and appeals (member/provider) via the 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 the preparation of complaint trend reports. • Assists in compiling claim data for customer audits. • Determines medical necessity, and 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.
Pay Range The typical pay range for this role is: Minimum: 17.00 Maximum: 27.16
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
Required Qualifications – Customer Service experiences in a transaction-based environment such as a call center or retail location preferred, demonstrating the ability to be empathetic and compassionate. – Experience in a production environment.
COVID Requirements
COVID-19 Vaccination Requirement CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), was
allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevent them from being 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 or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.
Preferred Qualifications Please see above.
Education High School Diploma
Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our hearts to every moment of our health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver.
Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion, and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.
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