Customer Service, New Business Operations- Hybrid Franklin, TN

CVS Health Corporation; Franklin (TN); Hybrid; USD 23,000 - 39,000; Full time

Benefits offered by this job

Medical insurance

Dental coverage

Vision coverage

Paid time off

Job summary

CVS Health in Franklin, TN is seeking a compassionate Customer Service Representative for New Business Operations. This hybrid role supports members, employers, providers by researching issues, handling inquiries, and documenting outcomes to ensure high satisfaction.

The ideal candidate has 1-3 years in a transaction-based customer service environment, strong Excel skills preferred, and HS diploma. 40 hours/week, Tue-Thu onsite, with benefits included.

Qualifications

• 1–3 years of customer service in a call center or retail setting.
• Demonstrating empathy and strong communication skills.
• HS Diploma or equivalent required.

Responsibilities

• Engage with members to resolve inquiries and explain benefits.
• Document outcomes and maintain accurate records in the system.
• Educate providers on self-service options; assist with credentialing.
• Handle claim referrals, appeals, and provider inquiries.
• Generate letters and spreadsheets using available tools.

Skills

Customer service

Empathy

Communication

Education

High School Diploma

Tools

Excel

SQL

Job description

Customer Service, New Business Operations- Hybrid Franklin, TN### Customer Service, New Business Operations- Hybrid Franklin, TNApply: Hybrid: TN - Franklin: Full time: Posted Today: End Date: November 10, 2026 (11 days left to apply): R1082677We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.**Position Summary** We are seeking a compassionate, customer-obsessed Customer Service Representative to care for our customers. Our customers include members of our benefit plans, employers that offer benefits, doctors, hospitals, and other providers of healthcare. As the face of our company, you will care for our customers by researching issues, documenting outcomes, resolving inquiries and delivering a high level of customer satisfaction. Your ability to listen and respond to customer needs is crucial in inspiring trust and loyalty. **What you will do:*** 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.* 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.* 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.* Performs financial data maintenance as necessary.* Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received. **Required Qualifications*** 3 days onsite Tuesday-Thursday in Franklin, TN* 1-3 years Customer Service experiences in a transaction based environment such as a call center or retail location preferred.* Demonstrating ability to be empathetic and compassionate.* Experience in a production environment. **Preferred Qualifications*** Proficient in Excel.* SQL experience a plus* Insurance Knowledge - Plus **Education*** High School Diploma**Anticipated Weekly Hours**40**Time Type**Full time**Pay Range**The typical pay range for this role is:$17.00 - $28.46This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.**Great benefits for great people**We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.This full‐time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‐being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.Additional details about available benefits are provided during the application process and on Benefits Moments.We anticipate the application window for this opening will close on: 11/10/2026Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.