Customer Service Representative (Arizona)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Summary Our Customer Service Representative is the face of Aetna/Mercy Care and impacts members' service experience by handling customer service inquiries and problems via telephone, internet, or written correspondence. For this role, customer inquiries are of basic and - at times - complex nature. General Responsibilities Engage, consult, and educate members, based upon the member’s unique needs, preferences, and understanding of Aetna plans, tools, and resources, in order to guide the members along a clear path to care. Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors. Triage any resulting rework to appropriate staff. Document and track contacts with members, providers, and plan sponsors. Guide members through benefits plan and Aetna policy & procedures, while maintaining knowledge of resources to comply with any regulatory guidelines. Take accountability to fully understand members’ needs by building a trusting and caring relationship with them. Anticipate customer needs. Provide the customer with related information to answer various questions; e.g. additional plan details, benefit plan details, member self-service tools, etc. Use customer service threshold framework to make financial decisions, in order to resolve member issues. Explain members’ rights and responsibilities in accordance with contract. Handle incoming requests for appeals and pre-authorizations, specifically those not handled by Clinical Claim Management. Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Perform other duties as needed.

At least 1 year of experience in a call center and/or high call-volume environment. At least 1 year of experience in health insurance, particularly Medicaid, Medicare, and/or Medicare Advantage. Working knowledge of Microsoft Office products (Word, Excel, PowerPoint, Outlook). Willingness to work a flexible schedule from Monday-Friday from 8am-6pm Arizona Time.

Demonstrated knowledge of medical terminology. Previous experience in a healthcare environment. Strong organizational and time management skills. Excellent communication skills. Ability to demonstrate empathy in a professional, customer-oriented manner. Previous experience in Medicare. Bilingual (English/Spanish).

High school diploma or GED. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $17.00 - $31.30 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.     Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness