Customer Srvc Rep - HCB Ops

Job DescriptionHandles 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.Pay RangeThe typical pay range for this role is:Minimum: 17.00Maximum: 27.16Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required Qualifications1-2 years Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.Preferred QualificationsCall Center experience in a high volume call center.EducationHigh School Diploma or equivalent.Business OverviewBring your heart to CVS Health Every 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.

Created: 2025-11-15