Customer Service Representative

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Description -Customer Service Representative is the face of Aetna and impacts members' service experience by manner of how customer service inquiries and problems via telephone, internet or written correspondence are handled.

-Customer inquiries are of basic and at times complex nature.

-Engages, consults and educates members based upon the member's unique 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. 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

• 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.

• 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.