Customer Service Representative – Work From Home

Job Description

As a Customer Service Representative in a fully remote role, requiring no prior experience. Youll provide top-notch support via phone, email, and chat, assisting customers with inquiries, issues, and product information. This is your chance to grow and excel from the comfort of your home. Apply today!

Position Summary

Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors. Triages resulting rework to appropriate staff. Provide excellent customer services for high volume in bound provider calls for the Claims Inquiry/Claims Research team. Extensive claims research on multiple platforms to assist providers with payment questions.
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 members 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 .
Educatesassists providers on our self-service options. Assists providers with credentialing and re-credentialing and contracting questions and issues.
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.

Required Qualifications

MUST live in the state of Florida full-time
Familiarity with Microsoft Office products
Experience in highly transactional call center environment
Excellent customer service and critical thinking
High speed internet access (25 mbps or higher) and consistent connection
Work location must be set up with a direct connection to the router (NOT Wi-Fi). We provide a 6 ½ foot long ethernet cord, if the distance is further, you will be required to provide your own ethernet cable.

Education

High School diploma or GED equivalent.

Pay Range

The typical pay range for this role is:$25.00 – $38.00

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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Companyâs 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (â??PTOâ?) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visitjobs.CVSHealth.com/benefits CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.CVS Health is committed to recruiting, hiring, developing, advancing, and retaining individuals with disabilities. As such, we strive to provide equal access to the benefits and privileges of employment, including the provision of a reasonable accommodation to perform essential job functions. CVS Health colleagues can initiate a request for a reasonable accommodation, including a qualified interpreter, written information in other formats, translation or other services through my HR (1-888-694-7287, or through my Leave at my HR). If you have a speech or hearing disability, please call 7-1-1 to utilize Telecommunications Relay Services (TRS). We will make every effort to respond to your request within 48 business hours and do everything we can to work towards a solution.