Apply on Employer Site

CVS Health · 20 hours ago

Customer Service Representative - Bilingual

United States

Full-time

Remote

New Grad, Entry Level

$17/hr - $34.15/hr

0+ years exp

CVS Health is the nation’s leading health solutions company, dedicated to transforming health care. They are seeking a Bilingual Customer Service Representative to handle customer inquiries and provide support to members, ensuring a positive service experience.

Health CareMedicalPharmaceuticalRetailSales

Responsibilities

Engages, consults and educates members based upon the member’s unique needs, preferences and under‐standing 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 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-ser‐vice 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-ser‐vice options; Assists providers with credentialing and re-credentialing issues

Responds to re‐quests 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 financial data maintenance as necessary. Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received

As a call center inbound representative you will be responsible for taking inbound Brokerage calls to provide application status, contract and appointment status

In addition you will review commission inquires, data entry, processing of Medicare contracts, appointments and verification of certification for external producers/agents to be eligible to market Medicare plans. May supplement the background check review and documentation process as well

Qualification

Bilingual (English/Spanish)Customer Service ExperienceEmpathy SkillsCommunication SkillsHealth PlansNavigate Systems

Required

6 months of Customer Service experience

Strong communication and empathy skills

Ability to navigate multiple systems and tools

Fluency in English and Spanish is required

Preferred

Knowledge of health plan benefits and regulatory requirements

Prior experience in healthcare, insurance, or call center environments is highly valued

Benefits

Affordable medical plan options

401(k) plan (including matching company contributions)

Employee stock purchase plan

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility