Customer Service Representative, Operations

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 The Call Center Representative serves as the primary point of contact for members, providers, and plan sponsors, delivering exceptional customer service through phone, digital, and written communication channels. This role is responsible for resolving inquiries, educating customers on benefits and available resources, advocating for customer needs, and creating positive service experiences. The representative demonstrates strong problem-solving skills, professionalism, empathy, and accountability while ensuring compliance with company policies and regulatory requirements.  This position operates on a hybrid work schedule, combining remote and in-office work. The representative must effectively manage responsibilities in both environments, maintain productivity and service standards, and adhere to all company policies related to attendance, security, and customer confidentiality.

Respond to member, provider, and plan sponsor inquiries through telephone, chat, email, and written correspondence. Resolve routine and complex customer concerns while delivering a high-quality customer experience. Accurately document customer interactions and maintain detailed records in applicable systems. Educate customers on plan benefits, policies, procedures, and self-service tools. Identify customer needs through active listening and provide personalized solutions and recommendations. Research and resolve claims, eligibility, billing, enrollment, and benefit-related issues. Coordinate escalations and referrals to appropriate departments when necessary. Demonstrate ownership of customer concerns through first-call resolution whenever possible. Maintain productivity, quality, compliance, and customer satisfaction standards. Support appeals, grievances, complaints, and authorization-related inquiries according to established guidelines. Utilize multiple systems and resources to investigate issues and provide accurate information. Adhere to HIPAA, regulatory requirements, and company policies regarding privacy and confidentiality. Participate in training, coaching, and continuous improvement initiatives. Contribute to a positive team environment by sharing knowledge and supporting organizational goals.

Minimum one year of customer service, call center, healthcare, insurance, or related experience preferred. Able to work a Hybrid schedule 3 days a week. Ability to navigate multiple systems while speaking with customers. Demonstrated problem-solving, critical thinking, and decision-making abilities. Ability to manage competing priorities in a fast-paced environment. Proficiency with Microsoft Office and customer relationship management systems.

Experience in healthcare, insurance, or benefits administration. Knowledge of claims, eligibility, appeals, and authorization processes. Experience supporting customers through multiple communication channels, including phone, chat, and email. Strong verbal and written communication skills. Strong attention to detail and organizational skills. Bilingual skills preferred where applicable.

High school diploma or GED equivalent Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $17.00 - $28.46 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,