Customer Service Representative - HCB Ops - Hybrid, Hartford CT

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.Position Summary
Customer Service Representative is the face of Aetna and impacts members' service experi- ence 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 mem- bers 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 appro- priate staff. Documents and tracks contacts with members, providers and plan sponsors. The CSR guides the member through their members plan of benets, Aetna policy and pro- cedures 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 an- swer the unasked questions, e.g. additional plan details, benet plan details, member selfservice tools, etc. Uses customer service threshold framework to make nancial 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-credential- ing issues. Responds to requests received from Aetna's Law Document Center regarding liti- gation; lawsuits Handles extensive le review requests. Assists in preparation of complaint trend reports. Assists in compiling claim data for customer audits. Determines medical ne- cessity, applicable coverage provisions and veries member plan eligibility relating to in- coming 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 benet maximums and/or coinsurance/deducti ble. Performs nancial 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 con- tracts, 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.Required Qualifications

• 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.