Job Responsibilities : Customer Service Representative
Salary : $14 per hour
Company : CVS Health
Location : Remote US
Educational requirements : High School
This position is a 100% work from opportunity
This position also includes a $1000 sign on bonus to be paid after 30 days. (Bonuses are only applicable to external candidates in specific positions locations and business groups. Applicable roles have the bonus language in the job posting).
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.
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. Assists in preparation of complaint trend reports. Assists in compiling claim data for customer audits. Determines medical necessity applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Performs financial data maintenance as necessary. Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
Familiarity with Microsoft office products
Claims or call center experience
High School diploma or GED equivalent.
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