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Job Responsibilities : Customer Service Representative

Salary : n

Company : CVS Health

Location : Remote US

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This Customer Service Role is for candidates in the CST Time Zone.

Training Schedule: 20-21 weeks ( NO PTO during training you will receive 4 floating days)

Times: 8am-5pmCST ( rotating schedule after training different shift each quarter based off performance. Shifts start at 5:55amCST to 8pmCST).

Health Concierge is the face of Aetna to provide targeted personalized service based on a holistic view of the member benefits health information and through engagement. Handles customer service inquiries and problems via telephone internet web-chat or written correspondence. Engages consults and educates members based upon the member’s unique needs preferences and understanding of Aetna plans tools and resources to help guide the members along a clear path to care. Utilizes resources to assist customers in understanding components of the Aetna products including claims accumulators usage and balances and cost sharing.

Answers questions and resolves issues as a “single-point-of-contact” based on phone calls plan sponsors PSS/ISO members and providers.
Provides customized interaction based on customer preference and individualized needs creating an emotional connection with our members by understanding and engaging the member to the fullest.
Fully understands the member’s needs by building a trusting and caring relationship with the member. Anticipates customer needs.
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.
Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e. assistance with member self-service tools Consultation Opportunities – Simple Steps Cost of Care Tools Natural Alternatives Program etc.)
Utilizes all relevant information to effectively influence member engagement
Takes immediate action when confronted with a problem or made aware of a situation
Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate
Identifies member needs beyond the initial inquiry by answering the unasked questions
Resolves issues without or with limited management intervention
Provides education to members to support them in managing their health
Responds quickly to meet customer needs and resolve problems while avoiding over-committing
Other activities may include: providing claim status information benefit coverage interpretations and explaining plan eligibility
Processes claim referrals new claim hand-offs and escalates issues as appropriate through the system for grievances and appeals
Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded
Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase post-enrollment member satisfaction
Partners with other departments to deliver client specific presentations
Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvement intended to enhance the overall delivery of service
Works collaboratively with colleagues to deliver the best customer experience Seeks to understand the customer including circumstances problems expectations and needs
Asks probing questions to identify the underlying customer needs
Appropriately transitions conversations to explore possibilities for extending customer interactions
Guides members to the appropriate health resource Offers alternatives where appropriate
Acts with the best interest of customer in mind and central to all interactions
Collaborates with colleagues and co-workers to deliver a world class customer experience
Serves as SME providing technical assistance when needed on call related issues products and/or system applications delivery matters
May participate in preparation and presentation of client specific presentations
May track and trend data
Coaches trains and assists in the development of call center staff as required
Participates in and/or leads special projects/initiatives addressing service issues as necessary
Provides technical or subject matter expertise concerning policies procedures and function-related applications/systems tools as needed
Delivers internal quality reviews
Provides appropriate support in third party audits when required
Documents and tracks all contacts events and outcomes with clients using appropriate systems and processes

Pay Range
The typical pay range for this role is:
Minimum: 17.00
Maximum: 27.16

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors including location.

Required Qualifications
Customer Service experiences in a transaction based environment such as a call center or retail location preferred demonstrating ability to be empathetic and compassionate.
Effective organizational skills and ability to manage multiple tasks.
Effective communication skills both verbal and written.

Preferred Qualifications
Customer Service experiences in a transaction based environment such as a call center or retail location preferred demonstrating ability to be empathetic and compassionate.
Effective organizational skills and ability to manage multiple tasks.
Effective communication skills both verbal and written.

Education
Associate’s degree or equivalent work experience

Business Overview
Bring your heart to CVS Health Every one of us at CVS Health shares a single clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal convenient and affordable. We strive to promote and sustain a culture of diversity inclusion and belonging every day. CVS Health is an affirmative action employer and is an equal opportunity employer as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting hiring promotion or any other personnel action based on race ethnicity color national origin sex/gender sexual orientation gender identity or expression religion age disability protected veteran status or any other characteristic protected by applicable federal state or local law. We proudly support and encourage people with military experience (active veterans reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

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