CVS Health · 10 hours ago
Customer Service New Business Operations
Franklin, TN
Full-time
Hybrid
Entry Level
$17/hr - $28.46/hr
1+ years expCVS Health is dedicated to building a world of health around every individual, offering a connected and compassionate health experience. The role focuses on creating emotional connections with members, understanding their needs, and providing comprehensive support and information related to their health plans.
RetailHealthcarePharmaceuticalHealth CareMedicalSales
Responsibilities
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 financial data maintenance as necessary
Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received
Qualification
Required
3 days onsite Tuesday-Thursday in Franklin, TN
1-3 years 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
High School Diploma
Preferred
Proficient in Excel
SQL experience a plus
Insurance Knowledge - Plus
Benefits
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an 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.
Company
CVS Health
CVS Health is a health solutions company that provides an integrated healthcare services to its members.
10001+ employees
Funding
Current Stage
Public CompanyTotal Funding
$4BKey Investors
Michigan Economic Development CorporationStarboard Value
2025-08-15Post Ipo Debt· $4B
2025-07-17Grant· $1.5M
2019-11-25Post Ipo Equity
Leadership Team
David Joyner
President and Chief Executive Officer, CVS Health
Chandra McMahon
SVP & CISO
Recent News
The Motley Fool
2026-02-08
legacy.thefly.com
2026-02-07
Hartford Business Journal
2026-02-06
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