Customer Service Representative - Remote Claims Inquiry and Research - Healthcare Customer Support

Join Our Team: Customer Service Representative - Remote Claims Inquiry and Research

Are you a motivated and customer-focused individual looking for a challenging and rewarding role in the healthcare industry? Do you have a passion for delivering exceptional customer service and resolving complex issues? If so, we want to hear from you! As a Customer Service Representative in our Claims Inquiry and Research team, you will have the opportunity to work in a fully remote environment, providing top-notch support to healthcare providers and members. This is an excellent opportunity to join a dynamic team and grow your career in a company that values its employees and the communities it serves.

About CVS Health

CVS Health is a leading healthcare company that is committed to helping people on their path to better health. With a diverse range of businesses, including retail pharmacy, pharmacy benefits management, and healthcare services, we are dedicated to providing innovative solutions that make healthcare more accessible and affordable. Our company culture is built on a foundation of respect, integrity, and compassion, and we strive to create a work environment that is inclusive, supportive, and empowering.

Job Summary

As a Customer Service Representative in our Claims Inquiry and Research team, you will play a critical role in providing exceptional customer service to healthcare providers and members. You will be responsible for answering questions, resolving issues, and triaging resulting rework to appropriate staff. This is a highly transactional call center environment, and you will be expected to work at a high level of productivity while maintaining excellent customer service skills.

Key Responsibilities

• Answer and resolve questions and issues from healthcare providers and members via phone calls and letters
• Triages resulting rework to appropriate staff and provides excellent customer service
• Conduct extensive claims research on multiple platforms to assist providers with payment questions
• Provide related information to customers, including plan details, benefit plan details, and member self-service tools
• Use customer service threshold framework to make financial decisions to resolve member issues
• Explain member benefits and processes claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals
• Assist in compiling claim data for customer audits and determine medical necessity, applicable coverage provisions, and verify member plan eligibility

Requirements and Qualifications

To be successful in this role, you will need to meet the following requirements and qualifications:

• Location: Must live in the state of Florida full-time
• Technical Requirements: High-speed internet access (25 mbps or higher) and consistent connection; work location must be set up with a direct connection to the router (NOT Wi-Fi)
• Software Skills: Familiarity with Microsoft Office products
• Experience: Experience in a highly transactional call center environment; no prior experience required
• Education: High School diploma or GED equivalent
• Skills: Excellent customer service and critical thinking skills

What We Offer

At CVS Health, we are committed to providing our employees with a comprehensive benefits package and a supportive work environment. Here are just a few of the benefits and perks we offer:

• Competitive Pay: The typical pay range for this role is $25.00 - $38.00 per hour
• Medical, Dental, and Vision Benefits: We offer a full range of medical, dental, and vision benefits to eligible employees
• Retirement Savings Plan: Eligible employees may enroll in our 401(k) retirement savings plan
• Employee Stock Purchase Plan: We offer an Employee Stock Purchase Plan to eligible employees
• Paid Time Off: Enjoy paid time off (PTO) or vacation pay, as well as paid holidays throughout the calendar year
• Well-being Programs: We offer numerous well-being programs, education assistance, free development courses, and a CVS store discount

Culture and Values

At CVS Health, we are committed to creating a work environment that is inclusive, supportive, and empowering. We value diversity and inclusion, and we strive to provide equal access to the benefits and privileges of employment. We are committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities.

How to Apply

If you are a motivated and customer-focused individual looking for a challenging and rewarding role in the healthcare industry, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and cover letter, to be considered for this role.

CVS Health is an equal opportunity employer and welcomes applications from diverse candidates. We are committed to providing a work environment that is free from harassment and discrimination, and we strive to create a culture of respect and inclusion.

Don't miss this opportunity to join our team and grow your career in a company that values its employees and the communities it serves. Apply today!