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Customer Service New Business Operations
| Company | CVS Health |
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| Location | Franklin, TN, USA |
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| Salary | $17 – $28.46 |
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| Type | Full-Time |
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| Degrees | |
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| Experience Level | Junior, Mid Level |
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Requirements
- 1-3 years Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.
- High School Diploma
- 3 days onsite Tuesday-Thursday in Franklin, TN
Responsibilities
- Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members’ best health.
- Takes accountability to fully understand the member’s needs by building a trusting and caring relationship with the member.
- Anticipates customer needs and provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.
- Uses customer service threshold framework to make financial decisions to resolve member issues.
- Explains member’s rights and responsibilities in accordance with contract.
- Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system.
- Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.
- Responds to requests received from Aetna’s Law Document Center regarding litigation; lawsuits Handles extensive file review requests.
- 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 relating to incoming correspondence and internal referrals.
- Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.
- 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 in response to inquiries received.
Preferred Qualifications
No preferred qualifications provided.
