Health Plan Customer Success Advocate

CVSHealth; Franklin (TN); On-site; USD 23,000 - 39,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health is seeking a compassionate Customer Service Representative in Franklin, TN for a full-time, on-site role with a 40-hour work week. You will care for members by researching issues, documenting outcomes, resolving inquiries and delivering high satisfaction levels.

Ideal candidates have 1–3 years in a transaction-based customer service setting and are empathetic. Proficiency with Excel is preferred; SQL knowledge is a plus.

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.

Responsibilities

• 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.

Skills

Customer service

Empathy

Production environment

Excel

SQL

Education

High School Diploma

Job description

CVS Health is seeking a compassionate Customer Service Representative in Franklin, TN for a full-time, on-site role with a 40-hour work week. You will care for members by researching issues, documenting outcomes, resolving inquiries and delivering high satisfaction levels.

Ideal candidates have 1–3 years in a transaction-based customer service setting and are empathetic. Proficiency with Excel is preferred; SQL knowledge is a plus.