Customer Service Representative

Job Opportunity At CVS Health

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.

Job Description

• You will work in front of a computer for approximately 8 hours speaking with members on the phone with little time in between calls during your scheduled phone hours.
• There is no standard scripting for this position. You will listen to the member's needs and provide direction on how to get them the care they may need.
• We want you to create an emotional connection with our members by understanding and engaging the member to the fullest. We want you to fully understand the member's needs by building a trusting and caring relationship with the member.
• That includes going beyond the initial inquiry and asking the unasked question to the member to ensure you are providing the most complete customer service experience that you can for our members.
• Provide the customer with related information to answer the unasked questions, e.g. additional plan details, benefit plan details, member self-service tools, etc.
• 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.
• Provides education to members to support them in managing their health.
• 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.
• Documents and tracks all contacts, events, and outcomes with members using appropriate systems and processes.
• Takes immediate action when confronted with a problem or made aware of a situation.
• Resolves issues without or with limited management intervention.
• Uses customer service threshold framework to make financial decisions to resolve member issues.
• 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.
• Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvement intended to enhance the overall delivery of service.
• Partners with other departments to deliver client specific presentations.
• Works collaboratively with colleagues to deliver the best customer experience.
• Appropriately transitions conversations to explore possibilities for extending customer 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.

Required Qualifications

• Must be flexible to work an 8 hour shift between 8am and 6pm EST.
• Customer Service experience in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.
• 1+ year of Microsoft Office Suite Experience.
• Must have experience working multiple screens and applications.
• Effective organizational skills and ability to manage multiple tasks.
• Effective communication skills, both verbal and written.

Education

• High School Diploma Required.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

$17.00 - $31.30

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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 07/04/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.