Customer Service Representative

Job DescriptionCustomer Service Representatives are the face of Aetna to provide targeted, personalized service based on a holistic view of the member, benefits, health information, and through engagement. Handles customer service inquiries and problems via telephone, internet, web-chat or written correspondence. Engages, consults and educates members based upon the member's unique needs, preferences and understanding of Aetna plans, tools and resources to help guide the members along a clear path to care. Utilizes resources to assist customers in understanding components of the Aetna products including claims, accumulators, usage and balances, and cost sharing.Required QualificationsFundamental Components Answers questions and resolves issues as a "single-point-of-contact" based on phone calls, plan sponsors, members and providers. Provides customized interaction based on customer preference and individualized needs, creating an emotional connection with our members by understanding and engaging the member to the fullest. Fully understands the member's needs by building a trusting and caring relationship with the member. Anticipates 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. Educates and assists customers on various elements of benefit plan information and available services created to enhance the overall customer service experience with the company (i.e., assistance with member self-service tools, Consultation Opportunities - Simple Steps, Cost of Care Tools, Natural Alternatives Program, etc.). Utilizes all relevant information to effectively influence member engagement. Takes immediate action when confronted with a problem or made aware of a situation. Takes ownership of each customer contact to resolve their issues and connect them with additional services as appropriate. Identifies member needs beyond the initial inquiry by answering the unasked questions. Resolves issues without or 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. Other activities may include: providing claim status information, benefit coverage interpretations, and explaining plan eligibility. Processes claim referrals, new claim hand-offs, and escalates issues as appropriate through the system for grievances and appeals. Initiates out-reach/welcome calls to ensure constituents expectations are met or exceeded. Identifies trends and any emerging customer service issues and works to develop solutions to address potential problems and/or plan features of interest as an approach to improve understanding of benefit plans and increase post-enrollment member satisfaction. Partners with other departments to deliver client specific presentations. Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvement intended to enhance the overall delivery of service. 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 the underlying customer needs. Appropriately transitions conversations to explore possibilities for extending customer interactions. Guides members to the appropriate health resource. Offers alternatives where appropriate . Acts with the best interest of customer in mind and central to all interactions. Collaborates with colleagues and co-workers to deliver a world class customer experience. Serves as SME providing technical assistance when needed on call related issues, products, and/or system applications delivery matters. May participate in preparation and presentation of client specific presentations. May track and trend data. Coaches, trains and assists in the development of call center staff, as required. Participates in and/or leads special projects/initiatives addressing service issues, as necessary. Provides technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools as needed. Delivers internal quality reviews. Provides appropriate support in third party audits when required. Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processesCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred QualificationsBackground Experience Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate. Effective organizational skills and ability to manage multiple tasks. Effective communication skills, both verbal and written Associate's degree or equivalent work experienceAdditional Job InformationInnovative Thinking and "Change Agent" - Looks for, identifies and acts on opportunities to improve how we design, develop, and deliver products and services. Strong analytical skills and innovative problem solving abilities. Strong negotiation and collaboration skills. In-depth knowledge of benefits program and system design (Health and Welfare, Wealth, other employee benefits), related financials, legal/regulatory requirements. Empathy towards customers' needs and concerns. Ability to maintain accuracy and production standards. Technical skills. Attention to detail and accuracy.EducationHigh School DiplomaBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2024-10-19