Customer Service Representative

questions.

• Educate provider with related information to answer the unasked questions, e.g., additional plan details, benefit plan details, provider self-service tools, etc.

• Use customer service threshold framework to make financial decisions to resolve provider issues. Explain provider's rights and responsibilities in accordance with contract.

• Process claim referrals, new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system.

• Assists providers with credentialing/re-credentialing and contracting questions and issues.

• Assist in compiling claim data for audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.

• Work hours will be between 7am to 7pm local time, Monday through Friday, and can vary periodically throughout the year. Advance notice will be given if schedules are changed.

Required Qualifications

• Familiarity with Microsoft Office products such as Outlook, Word, Teams, Excel

• Ability to maneuver through multiple system applications to gather information while on a call

• Excellent customer service and critical thinking is a must

• Must secure high speed internet access (100 mbps or higher) with consistent, stable connection. A speed test will be required to proceed with an interview.

• Work location must be set up with a direct connection to the router (NOT Wi-Fi). We provide a 6 ½ foot long ethernet cord, if the distance is further, you will be required to provide your own ethernet cable.

• Private workspace that is secure, quiet, and uninterrupted, and that allows appropriate maintenance of confidentiality as required by HIPAA and CVS Health guidelines.

Preferred Qualifications

• Healthcare background

• Experience in highly transactional call center environment

Education

• High School diploma or GED equivalent.

Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$17.00 - $34.15This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Great benefits for great peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefitsWe anticipate the application window for this opening will close on: 04/11/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.