Customer Service Representative

Bring 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.

Position Summary

Health Concierge is 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, webchat, 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 Qualifications

• Answers questions and resolves issues as a “single-point-of-contact” based on phone calls, plan sponsors, PSS/ISO, 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