Customer Service Agent – Overnight Customer Service Jobs

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

As a Customer Service Representative at Aetna, you will play a vital role in enhancing members’ service experience. You will handle customer inquiries and issues via telephone, internet, or written correspondence, ranging from basic to complex in nature. Your primary goal will be to engage, consult, and educate members based on their unique needs, preferences, and understanding of Aetna plans, tools, and resources. By building trusting relationships and creating emotional connections, you will guide members toward the best healthcare solutions.

Responsibilities:

• Handle customer inquiries and issues from members, providers, and plan sponsors.
• Document and track all interactions with members, providers, and plan sponsors.
• Provide information about Aetna plans, policies, procedures, and regulatory guidelines.
• Anticipate and address customer needs by offering related information proactively.
• Use customer service framework to make financial decisions and resolve member issues.
• Educate providers on self-service options and assist with credentialing matters.
• Respond to requests related to litigation and handle file reviews.
• Assist in preparing complaint trend reports and compiling claim data for audits.
• Determine medical necessity, coverage provisions, and member plan eligibility.
• Perform financial data maintenance as needed and produce quality documents and reports.
• Handle inbound Brokerage calls related to application status, contracts, and appointments.
• Review commission inquiries, process Medicare contracts, and verify certification for external producers/agents.

Requirements:

• Experience in a production environment.
• Customer service experience in a transaction-based environment (e.g., call center or retail) preferred, demonstrating empathy and compassion.
• High School diploma, G.E.D., or equivalent experience.

If you have a background in customer service, empathy, and a desire to help members navigate their healthcare journey, we encourage you to apply for the Customer Service Representative position at Aetna. Join our team and contribute to building strong relationships with members while ensuring they receive the care and support they need.