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:
This is a work at home opportunity.

Training and work schedule will be in accordance to Eastern Standard Time.

Shift and Training Schedule:

• 18 weeks for training - Training hours-8:00am-4:30pm EST  
• Shift hours must be available from 8am-8pm EST 

• Answers questions and resolves issues as a “single-point-of-contact” based on phone calls from plan sponsors, 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 plan features of interest as an approach to improve understanding of benefit plans and increase post-enrollment member satisfaction.
• Partners with other departments to deliver client specific presentations.
• Coordinates efforts both internally and across departments to successfully resolve service issues and develop process improvement intended to enhance the overall delivery of service.
• Works collaboratively with colleagues to deliver the best customer experience,.
• Seeks to understand the customer, including circumstances, problems, expectations and needs.
• Asks probing questions to identify the underlying customer needs.
• Appropriately transitions conversations to explore possibilities for extending customer interactions.
• 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.
• 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.
• Delivers internal quality reviews.
• Provides appropriate support in third party audits when required. Documents and tracks all contacts, events, and outcomes with clients using appropriate systems and processes

Required Qualifications:
• Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.
• Effective organizational skills and ability to manage multiple tasks.
• Effective communication skills, both verbal and written

Education:
High School Diploma Required

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.  
 
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities.  The Company offers a full range of medical, dental, and vision benefits.  Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees.  The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.  As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies.  
 
For more detailed information on available benefits, please visit Benefits | CVS Health

We anticipate the application window for this opening will close on: 01/10/2025

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