Customer Service Representative, New Business Operations
Core
Customer Service Representative handling benefits, claims, and member inquiries for CVS Health/Aetna to improve health and well-being.
Role type
Customer Service Representative (Health Insurance/Benefits)
Builds
Member satisfaction and accurate claims processing
Domain
Health Insurance / Benefits Administration
Deliverable
client delivery
Required skills
Empathy, active listening, problem-solving, data entry, financial decision-making, regulatory compliance knowledge
Preferred skills
Excel proficiency, SQL knowledge, insurance domain expertise
Responsibilities
Resolve member inquiries regarding benefits and claims, process claim referrals and appeals, verify member plan eligibility, handle grievance and appeals, assist providers with credentialing, compile claim data for audits, determine medical necessity and coverage provisions, maintain financial data, produce quality letters and spreadsheets
Seniority
Entry to Mid-level, hands-on IC