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

Responsibilities:

• Responds to inquiries and settles disputes from members, suppliers, and plan sponsors via phone calls and mail. assigning rework to the proper staff based on triage. For the Claims Inquiry/Claims Research team, respond to a large volume of incoming provider calls with exceptional customer service. thorough claims investigation across several platforms to support providers with payment-related inquiries.
• Provide the client relevant information—such as more plan specifics, benefit plan details, member self-service tools, etc.—to address their unanswered queries. employs a customer service threshold framework to guide financial judgments made in order to address member concerns. outlines each member’s obligations and rights under the terms of the contract.
• Uses the target system to handle claim referrals, new claim handoffs, nurse reviews, grievances, complaints, and appeals from both members and providers.
• Informs and helps providers about our possibilities for self-service. Helps providers with inquiries and concerns related to contracting, credentialing, and re-credentialing.
• Aids in gathering claim information for audits of customers. identifies the need for medical care, the relevant coverage terms, and the eligibility of the member plan in relation to incoming mail and internal referrals.

Requirements:

• MUST be a full-time resident of Florida
• Acquaintance with Microsoft Office
• Familiarity with a highly transactional call center
• Superior client support and analytical thinking
• Rapid internet access (25 mbps or more) with a reliable connection
• The work area needs to be configured with a wired connection to the router—not through WiFi. You will need to bring your own Ethernet wire if the distance is greater than the six feet that we give.

Instruction

• A GED equivalent or a high school diploma.

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