Customer Service Representative

que needs, preferences and understanding 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-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.

• This position pays a starting rate of $18.00/hr.Responsibilities

• Answering questions and resolving issues based on incoming calls from providers.

• Researching issues using multiple applications to assist providers

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

• Maintain department established performance metrics at a meets or exceeds expectations level

• Working together as a team and applying the Aetna Core Values in day-to-day operations

• Creating a Differentiated Service Experience

• Demonstrating Service Discipline

Required Qualifications

• 1 year of Customer Service experiences in a transaction-based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.

• Strong communication and problem-solving skills

• Strong computer navigation and typing skills -Ability to manage multiple tasks in a transaction / high volume-based environment

• Familiarity with Microsoft Office products

• Excellent customer service and critical thinking

• This is a fully remote position. Candidate must be able to work independently and be comfortable with virtual training and communication methods.

• Secure, private home office location where PHI/PII information is not visible or overheard by others.

• High speed internet access (100 mbps or higher) and consistent, reliable connection is required.

• Home office location must be set up with a direct connection to the router (Wi-Fi is not allowed).

• Full attendance is required for the entire training period, requests for time off or PTO during training cannot be accommodated.

Preferred Qualifications

1 year in a Healthcare setting.Education High School Diploma or EquivalentAnticipated Weekly Hours 40Anticipated Weekly Hours
40Time Type
Full timePay Range

The typical pay range for this role is:$17.00 - $31.30This 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: 09/09/2025Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.