Senior Quality Specialist-Hybrid Franklin, Tennessee

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Description:

Customer Service Representatives are the face of Aetna and impact the agent experience by manner of how customer service inquiries and problems via telephone, internet or written correspondence are handled. 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. Calls are typically non-routine and may require deviation from standard screens, scripts, and procedures to engage, consult and educate agents based upon the agent's unique needs, preferences and understanding of Aetna plans, tools, and resources.

Key Responsibilities:

• Possesses knowledge all Aetna health products available to the senior market.
• Gives guidance with sales inquiries
• Manages various software applications while taking calls when needed and documents processes effectively
• Cultivates positive and successful relationship with field sales force/broker/consultant community/customer teams
• Navigates and instructs the customer on how to use agent support website
• Completes sales orders and requests for materials
• Trains and mentors other employees if needed
• Assist Supervisor and Manager with providing support to the team
• Acts as an advocate and subject matter expert by serving as a customer service and quality champion.
• Executes both routine and non-routine business support tasks in the Commissions Operations teams under limited supervision, referring deviations from standard practices to managers.
• Provides effective and timely support to phone and email inquiries from agents.
• Measures and monitors the quality and effectiveness of work processes in commissions that impacts agent satisfaction and contributes to operational efficiency.
• Consults cross-functionally with other departments to influence and promote change, to continually deliver quality service to both internal and external customers.
• Acts as a subject matter expert on commission workflows and Commission Operations to consistently support agent inquiries.
• Will be responsible to analyze and resolve issues associated with agent commissions.
• Answers questions and resolves issues as a "single-point-of-contact" based on phone calls, emails, and internet from agents.
• Creates an emotional connection with our agents by being understanding and engaging.
• Taking accountability to fully understand the agent's needs by building a trusting and caring relationship with the agent.
• Anticipates agent’s needs and educates agent on various elements of information and available services created to enhance the overall customer service experience with the company (i.e., assistance with agent self-service tools).
• May provide technical or subject matter expertise concerning policies, procedures, and function-related applications/systems tools.
• Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes.

Additional Responsibilities to include but not limited to the following:

• Solid knowledge of prescription drug reimbursement, including insurance plan types, PBM and major medical benefits, prior authorizations and appeals processing.
• Ability to work in a fast paced environment, handling both inbound and outbound calls.
• Must be organized, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines.
• Good communication skills are essential, both internal and external.
• Knowledge of Medicare benefits, enrollments and LIS assistance.
• Plans and organizes work assignments, set priorities and completes work with a minimum of supervision.
• Adheres to the service policy and principles of the company, as well as the program guidelines set by the department.
• Participates in cross-training to perform all roles within the department. Communicates effectively and professionally with our program partners to assure the best possible service for our patients and partners.
• Other duties and projects as assigned.
• Must understand basic accounting including debits