Customer Service Representative
At Aetna, a CVS Health Company, we’re pioneering a total approach to health and wellness, focusing on the whole person - body, mind, and spirit. Our customer service and claim teams provide a human connection when it’s needed most and are essential to turning our member’s health ambitions, big and small, into achievements. Your role will include processing claims and helping members, doctors, and companies better understand our products and services. You will be an advocate for our member’s best health by helping them get the most from their benefits, building trust and always providing a clear path to care.
- Job Type: Full-time
- Job Level: Entry Level
- Travel: No
Aetna, a CVS Health Company’s minimum starting salary is $16/hr.
What makes a successful Customer Service Representative? Here are the traits we are looking for:
- Good listener
- Problem Solver
- Quick thinking
Paid Time Off & Disability
Aetna, a CVS Health Company’s Social Compact
Our commitment to improve wages and medical benefits.
Customer Service Representative Quotes
You really are invested in the member… you have to be their advocate.Damon H., Senior Health Concierge Customer Service Representative
I’m very excited about the common purpose [Advocate for our members’ best health by helping get them most from their benefits, building trust and always providing a clear path to care], in the first day of training all the leaders came in and explained it. As soon as they got done talking I knew this was the company for me.Emily E., Customer Service Representative
Customer Service RepresentativePrimary Location: Pittsburgh, Pennsylvania
Additional Locations: PA-Pittsburgh Apply
- Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors
- Triages resulting rework to appropriate staff
- Documents and tracks contacts with members, providers and plan sponsors
- The CSR guides the member through their members plan of benefits, Aetna policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines
- Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health
- Taking accountability to fully understand the member’s needs by building a trusting and caring relationship with the member while anticipating customer needs
- Provides the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.
- Uses customer service threshold framework to make financial decisions to resolve member issues
- Explains member's rights and responsibilities in accordance with contract.
- Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system
- Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues
- Responds to requests received from Aetna's Law Document Center regarding litigation; lawsuits
- Handles extensive file review requests.
- Assists in preparation of complaint trend reports
- Assists in compiling claim data for customer audits
- Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals
- Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management
- Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible
- Performs financial data maintenance as necessary
- Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received
- Customer Service experiences in a transaction based environment such as a call center or retail location preferred
- Ability to be empathetic and compassionate
- Experience in a production environment
- High School or GED equivalent.
- Ability to multi-task to accomplish workload efficiently.
- Understanding of medical terminology.
- Oral and written communication skills.
- Ability to maintain accuracy and production standards.
- Negotiation skills.
- Technical skills.
- Problem solving skills.
- Attention to detail and accuracy.
- Analytical skills.
Join our Talent Community
At Aetna, a CVS Health Company, we are pioneering a total approach to health and wellness and we need talented candidates like you to join our team. Become a member of our talent community to be the first to know about career initiatives that match your skills and interests as they become available, in addition to details on upcoming events, networking opportunities, and news about Aetna, a CVS Health Company.Sign Up
Sign up for Job Alerts
Explore This Area
Check out where you could be working if you apply.View Map
Join Our Talent Community
Sign up to receive information about job openings that are tailored to your skills and interests. Plus, get the latest career news from Aetna, a CVS Health Company.