Experienced Customer Service Representative - Aetna Health Insurance Plans, Inbound Call Center Operations, 24/7 Scheduling, Member Experience Focus

Join CVS Health and Bring Your Heart to Our Customer Service Team

At CVS Health, we're driven by a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to delivering enhanced human-centric health care for a rapidly changing world. As a leading health care company, we're dedicated to making health care more personal, convenient, and affordable. Our Heart At Work Behaviors support this purpose, empowering every employee to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions.

About the Role: Customer Service Representative

As a Customer Service Representative at Aetna, you'll be the face of our organization, impacting members' service experiences through your interactions via telephone, internet, or written correspondence. You'll engage, consult, and educate members based on their unique needs, preferences, and understanding of Aetna plans, tools, and resources to help guide them along a clear path to care. Our inbound call operation runs 24/7, 365 days a year, including weekends and holidays, so we need candidates who can work any shift, including overnights, weekends, and holidays.

Key Responsibilities:

• Answer questions and resolve issues from members, providers, and plan sponsors via phone calls, letters, or other correspondence.
• Triage resulting rework to appropriate staff and document and track contacts with members, providers, and plan sponsors.
• Guide members through their plan benefits, Aetna policies and procedures, and resources to comply with regulatory guidelines.
• Create an emotional connection with members by understanding and engaging with them to champion for their best health.
• Build trusting and caring relationships with members, taking accountability to fully understand their needs.
• Anticipate customer needs and provide related information to answer unasked questions.
• Use customer service threshold framework to make financial decisions to resolve member issues.
• Explain member rights and responsibilities in accordance with contract.
• Process claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals via target system.
• Educate providers on self-service options and assist with credentialing and re-credentialing issues.
• Respond to requests from Aetna's Law Document Center regarding litigation and lawsuits.
• Assist in preparing complaint trend reports and compiling claim data for customer audits.
• Determine medical necessity, applicable coverage provisions, and verify member plan eligibility relating to incoming correspondence and internal referrals.
• Handle incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.
• Perform reviews of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
• Perform financial data maintenance as necessary.
• Use applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.

Essential Qualifications:

• High school or GED equivalent.
• Customer service experience in a transaction-based environment, such as a call center or retail location.
• Ability to multi-task and accomplish workload efficiently.
• Understanding of medical terminology.
• Proficient oral and written communication skills.
• Proficient with Microsoft Word and Outlook.
• Ability to maintain accuracy and production standards.
• Negotiation skills.
• Technical skills.
• Problem-solving skills.
• Attention to detail and accuracy.
• Analytical skills.

Preferred Qualifications:

• Experience in a production environment.
• Demonstrated ability to be empathetic and compassionate.

What We Offer:

At CVS Health, we're committed to putting our heart into caring for our colleagues and our communities. Here are just a few of the benefits and rewards we offer:

• Competitive pay range: $17.00 - $29.88 per hour.
• Full range of medical, dental, and vision benefits.
• Eligible employees may enroll in our 401(k) retirement savings plan and Employee Stock Purchase Plan.
• Fully-paid term life insurance plan to eligible employees.
• Short-term and long-term disability benefits.
• Numerous well-being programs.
• Education assistance and free development courses.
• CVS store discount and discount programs with participating partners.
• Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year.

Why Join Us?

At CVS Health, we're dedicated to making a positive impact on the lives of our members and our communities. As a Customer Service Representative, you'll have the opportunity to:

• Make a difference in the lives of our members.
• Work with a talented and dedicated team.
• Develop your skills and advance your career.
• Enjoy a dynamic and supportive work environment.
• Be part of a company that's committed to putting our heart into everything we do.

How to Apply:

If you're passionate about delivering exceptional customer service and making a positive impact on the lives of our members, we encourage you to apply for this exciting opportunity. Please submit your application by May 17, 2024.

Don't miss this chance to join our team and bring your heart to CVS Health!

Apply for this job