Customer Service Representative – CVS Remote Jobs

Job Type: Customer Service Representative from home
Location: Florida work from home
Company: CVS Health

Any candidate can work permanently from home in this dental position (EST ONLY)

Responsibilities:

The Dental Customer Service Representative is Aetna’s public face, and how they reply to members’ questions and problems when they contact them by phone, email, or other means of written communication affects how well they are treated.

• Customer enquiries might range from simple to sophisticated in nature.
• Engages, consults, and enlightens members based on their particular requirements, preferences, and comprehension of Aetna plans, tools, and resources in order to assist in directing them along a clear route to treatment.
• Responds to queries and handles problems depending on correspondence from members, suppliers, and plan sponsors.
• delegates rework that results to the proper staff.
• maintains a record of all communications with plan sponsors, providers, and members.
• The Dental CSR explains the member’s benefits plan, Aetna policies and processes, and provides information for adhering to any regulatory requirements.
• establishes an emotional bond with our members by fully comprehending and interacting with them in order to advocate for their optimum health.
• creating a trustworthy and caring relationship with the member in order to completely grasp the member’s requirements.
• considers the needs of the client.
• gives the consumer pertinent information to address any unanswered queries, such as more specifics on the plan or benefits, member self-service resources, etc.
• When making financial decisions to address member difficulties, the customer service threshold framework is used.
• explains the contract-required obligations and rights of the member.
• Utilizes the target system to handle claim referrals, new claim handoffs, nurse reviews, complaints (from members and providers), grievances, and appeals (from members and providers).
• Provider assistance with difficulties related to credentialing and re-credentialing; education of providers on our self-service choices.
• responds to inquiries about litigation and cases from Aetna’s Law Document Center.
• responds to requests for comprehensive file reviews.
• helps to create reports on complaint trends.
• aids in gathering claim information for client audits.
• Verifies member plan eligibility in relation to inbound letters and internal referrals, as well as applicable coverage provisions and medical necessity.
• handles incoming appeals and pre-authorization requests that Clinical Claim Management is unable to manage. To ensure correct tracking of benefit maximums and/or coinsurance/deductibles, perform a review of the member’s claim history.
• if necessary, performs maintenance on financial data. Utilizes pertinent system resources and tools to create effective letters and spreadsheets in answer to questions.

Pay Scale:

The usual pay scale for this position is as follows:

17.00 minimum; 27.90 maximum

Please remember that this range represents the salary range for every position in the job grade that this position belongs to. The location is just one of several variables that will be considered when determining the actual compensation offer.

Requirements:

• Experiences with customer service in a transaction-based setting, such as a call center or retail store, are preferred. These experiences should highlight your empathy and compassion.
• Knowledge of a production setting.

Preferred Requirements: Observe the above.

Education: Diploma from high school