Customer Service New Business Operations
CVS Health is dedicated to building a world of health around every individual, and they are seeking a Customer Service New Business Operations professional to enhance member engagement. This role involves creating emotional connections with members, understanding their needs, and providing relevant information to ensure a compassionate health experience.
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
- 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
- High School Diploma
- Proficient in Excel
- SQL experience a plus
- Insurance Knowledge - Plus
Benefits
- Medical, dental, and vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
Company Overview