Job Description
Title: Customer Service Representative
Location: Work from home PA US
Category: Customer and Member Services
Job Type: Fully remote
Salary: 17.00 27.90
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 humancentric 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
Pay $17.50/hr
Meritain Health’s Call Center has multiple openings for Customer Service Representatives to support our Buffalo, NY office. This is a work from home position across the state of NY. (Buffalo & its surrounding suburbs/ Erie County/Niagara County/Western NY Area/Ohio/PA/NYC)
- This position handles customer service inquiries and problems via telephone, internet or written correspondence.
- Customer inquiries are of basic and routine nature.
- 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 selfservice 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 selfservice options; Assists providers with credentialing and recredentialing 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 preauthorizations 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.
Required 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.
- Schedule: 8am4:30pm EST
Preferred Qualifications
- Please review required qualifications above.
Education
- High School Diploma, GED or equivalent experience.