Customer Service Representative (Must live/work East Coast Time Zone) ID-8332

About the position

The Customer Service Representative at CVS Health is responsible for providing exceptional service to members, plan sponsors, and providers through effective communication and problem-solving. This role emphasizes building trusting relationships with customers, understanding their needs, and delivering tailored solutions to enhance their healthcare experience. The position is remote, requiring availability during Eastern Standard Time for training and work shifts.

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Responsibilities

  • Answers questions and resolves issues as a single point of contact based on phone calls from plan sponsors, members, and providers.
  • Builds a trusting and caring relationship with members to fully understand their needs.
  • Anticipates customer needs and provides related information to answer unasked questions.
  • 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.
  • Utilizes all relevant information to effectively influence member engagement.
  • Takes immediate action when confronted with a problem or situation.
  • Takes ownership of each customer contact to resolve issues and connect them with additional services.
  • Identifies member needs beyond the initial inquiry by answering unasked questions.
  • Resolves issues 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.
  • Processes claim referrals, new claim hand-offs, and escalates issues as appropriate.
  • Initiates outreach/welcome calls to ensure expectations are met or exceeded.
  • Identifies trends and emerging customer service issues and develops solutions.
  • Partners with other departments to deliver client-specific presentations.
  • Coordinates efforts internally and across departments to resolve service issues and develop process improvements.
  • 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 underlying customer needs.
  • Transitions conversations to explore possibilities for extending customer interactions.
  • Guides members to appropriate health resources and offers alternatives where appropriate.
  • Acts with the best interest of the customer in mind during all interactions.
  • Serves as a subject matter expert providing technical assistance on call-related issues.
  • May participate in preparation and presentation of client-specific presentations.
  • May track and trend data, coach, train, and assist in the development of call center staff.
  • Participates in and/or leads special projects addressing service issues as necessary.
  • Delivers internal quality reviews and provides support in third-party audits.

Requirements

  • Customer service experience in a transaction-based environment such as a call center or retail location preferred.
  • Demonstrated ability to be empathetic and compassionate.
  • Effective organizational skills and ability to manage multiple tasks.
  • Effective communication skills, both verbal and written.
  • High School Diploma required.

Benefits

  • Medical, dental, and vision benefits.
  • 401(k) retirement savings plan.
  • Employee Stock Purchase Plan.
  • Fully-paid term life insurance plan.
  • Short-term and long-term disability benefits.
  • Well-being programs.
  • Education assistance and free development courses.
  • CVS store discount and discount programs with participating partners.
  • Paid Time Off (PTO) and paid holidays.

Customer Service Representative (Must live/work East Coast Time Zone) ID-8332

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