Job Responsibilities : Customer Service Representative – Work from Home
Salary : $14 per hour
Company : CVS Health
Location : Remote US
Educational requirements : High School
- Handles provider customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.
- 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.
- Explains member’s benefits, rights and responsibilities in accordance with contract to our providers.
- Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.
- Determines applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
- Handles incoming status requests for appeals and pre-authorizations not handled by Clinical Claim Management .
- Performs review of member/provider claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
- Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.