Customer Service Representative, Medical Review/...

Join Us At CVS Health We're building a world of health around every individual shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger helping to simplify health care one person, one family and one community at a time. Position Summary Operates as a representative of the company by answering and documenting all incoming contacts to determine their nature while responding to complex calls related to specialized services. Ensures that every member is shown respect and kindness and that all questions are thoroughly answered to ensure a high level of customer satisfaction and loyalty. Identifies and evaluates appropriate data to determine and implement the appropriate course of action to resolve the complaint and/or coordinate service recovery. Follows established procedures to meet customer/member needs and successfully enhance the company's brand recognition and competitive advantage in the industry. Handles the answering of questions regarding A&H and FE plans so that our members better understand their coverage. Communicates effectively with diverse work units and relevant organizational departments to ensure that issues are properly and quickly resolved. Performs required tasks using tools available to recall necessary information. Documents all customer correspondence and maintains confidential records of patient information. Required to meet all company set metrics. First call resolution mind set. Required Qualifications 6+ months previous call center experience or customer service. Multitasking capability with superb time management. Excellent verbal and written communication, active listening, and the ability to express information clearly. Patience, empathy, and the ability to handle difficult customers professionally. Basic computer skills and ability to navigate phone systems and software. Experience with de-escalations. Preferred Qualifications Experience with accident and health and whole life insurance Claims experience Familiar with medical terminology Working knowledge of problem solving and decision making skills Education High school diploma or up to 1 year equivalent experience. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $17.00 - $28.46 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great Benefits For Great People We take pride in our comprehensive and competitive mix of pay and benefits investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Created: 2026-03-10