Note: The job is a remote job and is open to candidates in USA. CVS Health is hiring a Customer Service Representative to support Aetna/Mercy Care members. The role handles inquiries and issues, explains benefits and policies, documents interactions, and processes certain appeals and pre-authorization requests while following regulatory guidelines.
Responsibilities
- Engage, consult, and educate members, based upon the member’s unique needs, preferences, and understanding of Aetna plans, tools, and resources, in order to guide the members along a clear path to care
- Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors
- Triage resulting rework to appropriate staff
- Document and track contacts with members, providers, and plan sponsors
- Guide members through benefits plan and Aetna policy & procedures, while maintaining knowledge of resources to comply with any regulatory guidelines
- Take accountability to fully understand members’ needs by building a trusting and caring relationship with them
- Anticipate customer needs
- Provide the customer with related information to answer various questions; e.g. additional plan details, benefit plan details, member self-service tools, etc
- Use customer service threshold framework to make financial decisions to resolve member issues
- Explain members’ rights and responsibilities in accordance with contract
- Handle incoming requests for appeals and pre-authorizations, specifically those not handled by Clinical Claim Management
- Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible
Skills
- At least 1 year of experience in a call center and/or high call-volume environment
- Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook)
- High school diploma or GED
- Demonstrated knowledge of medical terminology
- Previous experience in a healthcare environment
- Strong organizational and time management skills
- Excellent communication skills
- Ability to demonstrate empathy in a professional, customer-oriented manner
Benefits
- Medical, dental, and vision coverage, based on eligibility
- Paid time off, based on eligibility
- Retirement savings options, based on eligibility
- Wellness programs, based on eligibility
- Work at home in Arizona
Company Overview