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Customer Service Representative

2 months ago

Trenton, New Jersey, United States CVS Health Full time
Job Summary

This role is a key member of the Claims Inquiry/Claims Research team at CVS Health, providing exceptional customer service to healthcare providers and members. The successful candidate will be responsible for answering questions, resolving issues, and providing claims research support to ensure timely and accurate payment of claims.

Key Responsibilities
  • Customer Service: Provide high-quality customer service to healthcare providers and members, responding to phone calls, letters, and emails in a timely and professional manner.
  • Claims Research: Conduct extensive claims research on multiple platforms to assist providers with payment questions, ensuring accurate and timely resolution of issues.
  • Claim Referrals and Processing: Process claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals via the target system.
  • Provider Support: Educate and assist providers on self-service options, credentialing, re-credentialing, and contracting questions and issues.
  • Data Compilation: Assist in compiling claim data for customer audits, determining medical necessity, applicable coverage provisions, and verifying member plan eligibility.
Requirements
  • Technical Skills: Familiarity with Microsoft Office products, including Word, Teams, and Excel, as well as the ability to maneuver through multiple applications to gather information while on a call.
  • Experience: Experience in a highly transactional call center environment, with excellent customer service and critical thinking skills.
  • Internet and Hardware Requirements: Must secure high-speed internet access (100 Mbps or higher) and a consistent, stable connection, with a direct connection to the router (not Wi-Fi).
Preferred Qualifications
  • Healthcare Background: Healthcare background or experience in a related field.
Education
  • High School Diploma or Equivalent: High school diploma or GED equivalent.
Compensation

The typical pay range for this role is $28.46 per hour. 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.