# Customer Service Representative

**Company**: CVS Health
**Location**: Franklin, TN
**Work arrangement**: hybrid
**Job type**: full-time
**Salary**: $17.00 - $28.46
**Category**: Customer Service
**Industry**: Healthcare

**Apply**: https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/TN---Franklin/Customer-Service-New-Business-Operations--Hybrid-Franklin--TN_R1082677?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply
**Canonical**: https://yubhub.co/jobs/job_462e550d-9dd

## Description

We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience.

As a Customer Service Representative, you will care for our customers by researching issues, documenting outcomes, resolving inquiries, and delivering a high level of customer satisfaction.

**Responsibilities:**

- Creates an emotional connection with members by understanding and engaging them to champion for their best health.

- Takes accountability to fully understand members' needs by building a trusting and caring relationship.

- Anticipates customer needs.

- Provides customers with related information to answer unasked questions.

- 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, grievance, and appeals.

- Educates providers on self-service options and assists with credentialing and re-credentialing issues.

- Responds to requests received from Aetna's Law Document Center regarding litigation.

- 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.

- Handles incoming requests for appeals and pre-authorizations.

- 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.

**Requirements:**

- 3 days onsite Tuesday-Thursday in Franklin, TN

- 1-3 years Customer Service experience in a transaction-based environment

- Demonstrated ability to be empathetic and compassionate

- Experience in a production environment

**Preferred Qualifications:**

- Proficient in Excel

- SQL experience a plus

- Insurance Knowledge - Plus

**Education:**

- High School Diploma

**Anticipated Weekly Hours:** 40

**Time Type:** Full-time

**Pay Range:** $17.00 - $28.46

**Benefits:** We offer a comprehensive benefits package, including medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources.

## Skills

### Required
- Customer Service
- Communication
- Problem-solving

### Nice to have
- Excel
- SQL
- Insurance Knowledge

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Source: [Apply at cvshealth.wd1.myworkdayjobs.com](https://cvshealth.wd1.myworkdayjobs.com/en-US/CVS_Health_Careers/job/TN---Franklin/Customer-Service-New-Business-Operations--Hybrid-Franklin--TN_R1082677?utm_source=yubhub.co&utm_medium=jobs_feed&utm_campaign=apply)