Customer Service Representative - Work From Home (CST or EST Time Zones)

CVS Health; Richmond (VA); Remote; USD 10,000 - 60,000; Full time

Job summary

A leading health solutions company located in Richmond, Virginia is seeking a Customer Service Representative. This role involves addressing member inquiries and guiding them on their health plans. Ideal candidates will have prior customer service experience and a commitment to supporting member needs and rights. The position offers comprehensive benefits and opportunities for growth, with standard working hours from home.

Benefits

Affordable medical plan options

401(k) plan

Employee stock purchase plan

Wellness programs

Tuition assistance

Qualifications

• 1+ years of Customer Service experience required.
• Must have high speed internet with speeds above 25mbps.
• Must be willing to work Monday - Friday with remote capabilities.

Responsibilities

• Handle inquiries and problems via multiple communication methods.
• Educate members on their plans and guide them through questions.
• Document and track interactions with members and providers.
• Resolve customer inquiries with a focus on care and support.

Skills

Customer Service

Problem Solving

Communication

Healthcare Knowledge

Education

High School diploma or equivalent

Job description

Position Summary

We are currently recruiting top talent for our Center of Excellence Customer Service group. Responsibilities below include, but not limited to:

We are CVS Health, a leading health solutions company; we reach millions of Americans through our local presence, digital channels and more than 300,000 colleagues working to transform health care with heart, every day.

Responsibilities

• Customer Service Representative is the face of Aetna and impacts members' service experience by handling inquiries and problems via telephone, internet or written correspondence.
• Handle basic to complex customer inquiries.
• Engage, consult and educate members based on their needs, preferences and understanding of Aetna plans, tools and resources to guide them along a clear path to care.
• Answer questions and resolve issues from members, providers and plan sponsors; triage resulting rework to appropriate staff.
• Document and track contacts with members, providers and plan sponsors; guide the member through their plan benefits, policies and procedures; comply with regulatory guidelines.
• Create an emotional connection with members and champion their best health; build trust and anticipate needs.
• Provide related information to answer unasked questions (e.g., additional plan details, member self-service tools).
• Use customer service threshold framework to help resolve member issues, including financial considerations when applicable.
• Explain member rights and responsibilities in accordance with the contract.
• Process claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), and grievances/appeals via target system.
• Educate providers on self-service options; assist with credentialing and re-credentialing issues.
• Respond to requests from Aetna's Law Document Center regarding litigation; handle extensive file review requests.
• Assist in preparation of complaint trend reports and in compiling claim data for customer audits.
• Determine medical necessity, applicable coverage provisions and verify member plan eligibility related to incoming correspondence and internal referrals.
• Handle incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.
• Review member claim history to ensure accurate tracking of benefit maximums and coinsurance/deductible.
• Perform financial data maintenance and use system tools to produce quality letters and spreadsheets in response to inquiries.

Required Qualifications

• 1+ years of Customer Service.
• Must have high speed internet with consistent speeds above 25mbps and adherence to telework agreement (wired).
• Must be willing to work Monday - Friday 8:35a-5:05p or 9:30a-6:00p EST; training and working hours are remote.

Preferred Qualifications

• 1+ years of Healthcare experience.
• Experience in a production environment.
• Prior experience providing customer service to the senior population; knowledge of medical terminology including Medicare and Medicaid policies.

Education

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

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$17.00 - $31.30

This 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• 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 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 10/06/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.