Customer Srvc Rep - Hcb Ops

Handles provider customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.

• Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.
• Explains member's benefits, rights and responsibilities in accordance with contract to our providers.
• Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
• Determines applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
• Performs review of member/provider claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
• Handles incoming status requests for appeals and pre-authorizations not handled by Clinical Claim Management .
• Answers questions and resolves issues based on phone calls/letters from providers. Triages resulting rework to appropriate staff. Documents and tracks contacts with members, providers and plan sponsors.

Pay Range
The typical pay range for this role is:
Minimum: 17.00
Maximum: 27.90
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
1-2 years Customer Service experience in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.
Preferred Qualifications
Call center experience
Medical/Insurance terminology
Education
High School Diploma or equivalent 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.