We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Position Summary
Customer Service Representative is the face of Aetna and impacts members' service experience by manner of how customer service inquiries and problems via telephone, internet or written correspondence are handled. Customer inquiries are of basic and at times complex nature.
- Engages, consults and educates members based upon the member’s unique needs, preferences and under‐standing of Aetna plans, tools and resources to help guide the members along a clear path to care.
- 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-ser‐vice tools, etc.
- Uses customer service thresh‐old 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 in‐coming 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.
- As a call center inbound representative you will be responsible for taking in‐bound Brokerage calls to provide application status, contract and appointment status.
The starting pay for this position is $19.02/hour.
Please note training is up to 10 weeks, 8 hours per day, Monday - Friday (Can be scheduled to start as early as 7am in your time zone and end as late as 7pm in your time zone). Time off requests will not be approved during training.
Permanent schedules can be assigned with start times as early as 8am EST and end as late as 8pm EST.
Required Qualifications
- Must be fluent in English and Spanish.
- Strong communication and empathy skills.
- Ability to navigate multiple systems and tools.
- Knowledge of health plan benefits and regulatory requirements.
Preferred Qualifications
- Prior experience in healthcare, insurance, or call center environments is highly valued.
- A location in the Eastern Time Zone is preferred.
Education
- High School Diploma or GED
Anticipated Weekly Hours
40
Time Type
Full time
Pay Range
The typical pay range for this role is:
$17.00 - $34.15
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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.
This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
Additional details about available benefits are provided during the application process and on Benefits Moments.
We anticipate the application window for this opening will close on: 05/23/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.