CVS Health

Customer Service Representative- $16 hour starting wage- Work at Home

Posted 5 days ago

Job Description

Job Description
Temporary work from home. $16/hr. starting wage

Meritain Health, an Aetna/CVS affiliate, has multiple openings for Customer Service Representatives to support our Plymouth, MN office.

* This position handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.
* 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 members 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
* 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.

Required Qualifications
Handle incoming calls from members and providers regarding claims status, benefits and eligibility, PPO participation, etc
* Maintain department established performance metrics at a meets or exceeds expectations level
* Work together as a team and apply the Aetna Core Values in day-to-day operations
* Creating a Differentiated Service Experience
* Demonstrating Service Discipline
* Handling Service Challenges
* Providing Solutions to Constituent Needs
* Working Across Boundaries

Preferred Qualifications
* Call center and medical terminology/insurance experience
* Experience in a production environment

High School diploma, G.E.D. or equivalent experience

Business Overview
At Aetna, a CVS Health company, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We are committed to maintaining a diverse and inclusive workplace. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, gender, gender identity, age, disability or protected veteran status. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.