by Chris Durst Dec. 8, 2022
Meritain Health, an Aetna/CVS affiliate, has posted openings for Work from Home Customer Service Representatives.
Pay starts at $17.50/hr. and has a range up to $27.16/hr.
As no computer specs are noted in the job listing, and CVS affiliate companies generally provide equipment to remote workers, we assume that a computer is provided, but that’s not official.
College is not required. While you do have to live in the US, no state exclusions are noted in the listing.
Here’s what the company has posted about the job:
Meritain Health, an Aetna/CVS affiliate, has multiple openings for Customer Service Representatives. This position handles customer service inquiries and problems via telephone, internet or written correspondence. Customer inquiries are of basic and routine nature.
- Answers questions and resolves issues based on phone calls/letters from members, providers, and plan sponsors.
- Triages resulting rework to appropriate staff.
- Documents and tracks contacts with members, providers and plan sponsors.
- The CSR guides the member through their members plan of benefits, Aetna policy and procedures as well as having knowledge of resources to comply with any regulatory guidelines.
- Creates an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members’ best health.
- Taking accountability to fully understand 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.
- Explains member’s rights and responsibilities in accordance with contract.
- Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system.
- Educates providers on our self-service options; Assists providers with credentialing and re-credentialing issues.
- Responds to requests received from Aetna’s Law Document Center regarding litigation; lawsuits Handles extensive file review requests.
- Assists in preparation of complaint trend reports.
- Assists in compiling claim data for customer audits.
- Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.
- Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.
- Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
- Performs financial data maintenance as necessary.
- Uses applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
The typical pay range for this role is:
Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.
- Customer Service experiences in a transaction based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.
- Experience in a production environment.
- High School or GED equivalent.
Please review required qualifications above.
High School diploma, G.E.D. or equivalent experience.
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