Job Description
Bilingual Customer Service Representative (English + Japanese)
remote type
Remote
locations
FL – Tampa
time type
Full time
job requisition id
R0087115
Job Description:
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your 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.
Position Summary
- Customer Service Representative is the face of Aetna and impacts members’ service experience by manner of how 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 upon 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.
- We are a 24/7 customer service inbound call operation. Our calls are 24 x 7, 365 days a year which includes weekends and holidays. Being able to work any shift which includes overnights weekend and holidays is a requirement for this position. We are looking for candidates who can work ANY shift based on business needs.
- 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 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.
Required Qualifications
Please replace this section with the Required Job Qualifications
Preferred Qualifications
- 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.
- Ability to multi-task to 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
Education
High School or GED equivalent.