Customer Service Representative - Work from Home in Florida - Transforming Healthcare through Exceptional Customer Experience

Join the CVS Health Team: Revolutionizing Healthcare with Heart At CVS Health, we're on a mission to bring our heart to every moment of your health. Our purpose is clear: to deliver enhanced human-centric health care for a rapidly changing world. As a Customer Service Representative working from home in Florida, you'll play a vital role in transforming our culture and accelerating our ability to innovate and deliver solutions that make health care more personal, convenient, and affordable. About Our Company Culture Our Heart At Work Behaviors guide our commitment to delivering exceptional customer service. We empower our employees to take ownership of their role in transforming our culture and driving innovation. As a Customer Service Representative, you'll be part of a dynamic team that's dedicated to providing high-quality support to our members, providers, and plan sponsors. Job Summary We're seeking a highly skilled and motivated Customer Service Representative to work from home in Florida. As a Customer Service Representative, you'll be the primary point of contact for our members, providers, and plan sponsors, resolving issues and answering questions via phone and email. You'll work in a fast-paced, dynamic environment, utilizing multiple platforms to research and resolve claims, and providing exceptional customer service. Key Responsibilities Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors, triaging resulting rework to appropriate staff. Provides excellent customer service for high-volume inbound provider calls for the Claims Inquiry/Claims Research team, conducting extensive claims research on multiple platforms to assist providers with payment questions. Educates and assists providers on our self-service options, and assists with credentialing and re-credentialing and contracting questions and issues. Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. Determines medical necessity, applicable coverage provisions, and verifies member plan eligibility relating to incoming correspondence and internal referrals. Assists in compiling claim data for customer audits, and provides related information to answer unasked questions, such as additional plan details, benefit plan details, and member self-service tools. Requirements and Qualifications Essential Qualifications Must live in the state of Florida full-time. High School diploma or GED equivalent. Familiarity with Microsoft Office products. Experience in a highly transactional call center environment. Excellent customer service and critical thinking skills. High-speed internet access (25 mbps or higher) and consistent connection. Work location must be set up with a direct connection to the router (NOT Wi-Fi). Preferred Qualifications Previous experience in the healthcare industry. Knowledge of healthcare terminology and concepts. Experience working with multiple platforms and systems. Skills and Competencies To succeed in this role, you'll need to possess excellent communication and interpersonal skills, with the ability to work in a fast-paced, dynamic environment. You'll need to be proactive, with strong problem-solving and analytical skills, and be able to work independently with minimal supervision. Career Growth Opportunities and Learning Benefits At CVS Health, we're committed to helping our employees grow and develop in their careers. As a Customer Service Representative, you'll have access to ongoing training and development opportunities, including virtual training sessions and online resources. You'll also have the opportunity to advance to leadership roles or specialize in a particular area of customer service. Work Environment and Company Culture Highlights As a remote worker, you'll enjoy the flexibility and autonomy of working from home, while still being part of a dynamic and supportive team. Our company culture is built on a foundation of empathy, compassion, and respect, and we're committed to creating a work environment that's inclusive and engaging. Compensation, Perks, and Benefits We offer a competitive compensation package, with a pay range of $17.00 - $25.15 per hour, depending on experience and qualifications. In addition to your compensation, you'll enjoy a range of benefits, including: Medical, dental, and vision benefits. 401(k) retirement savings plan and Employee Stock Purchase Plan. Fully-paid term life insurance plan and short-term and long-term disability benefits. Numerous well-being programs and education assistance. CVS store discount and discount programs with participating partners. Paid Time Off (PTO) and paid holidays throughout the calendar year. Conclusion If you're a motivated and customer-focused individual with a passion for delivering exceptional service, we want to hear from you. As a Customer Service Representative working from home in Florida, you'll play a vital role in transforming our culture and driving innovation at CVS Health. Apply now to join our team and start making a difference in the lives of our members and customers. If you think this role describes you, we would love to hear from you. Apply now to join our team!