Bilingual Customer Service Representative – English and Spanish Speaking, Delivering Exceptional Healthcare Experiences to Diverse Communities

Introduction to CVS Health

At CVS Health, we are driven by a singular purpose: to bring our heart to every moment of your health. This guiding principle underscores our commitment to delivering human-centric healthcare that is both personal and transformative. As a leader in the healthcare industry, we recognize that the manner in which we deliver our services is just as crucial as the services themselves. Our brand, with heart at its core, sends a powerful message about the importance of empathy, compassion, and understanding in healthcare. If you are passionate about making a meaningful difference in the lives of others, we invite you to join our team as a Bilingual Customer Service Representative, where you will play a vital role in shaping the healthcare experience for our members.

Our Heart At Work Behaviors

Our Heart At Work Behaviors are the foundation upon which our culture is built. These behaviors empower every colleague to feel valued, respected, and inspired to contribute to our mission of transforming healthcare. By living these behaviors, we create an environment that is collaborative, innovative, and patient-centered. As a Bilingual Customer Service Representative, you will embody these behaviors, leveraging your skills and experience to make a positive impact on our members' lives.

Position Summary

The Bilingual Customer Service Representative is the face of Aetna, responsible for delivering exceptional service experiences to our members through various channels, including telephone, internet, and written correspondence. In this role, you will engage with members, providers, and plan sponsors to address inquiries, resolve issues, and provide education on Aetna plans, tools, and resources. Your ability to communicate effectively in both English and Spanish will enable you to connect with a diverse range of members, understanding their unique needs, preferences, and concerns.

Key Responsibilities

• Answer questions and resolve issues via phone calls, letters, or internet inquiries from members, providers, and plan sponsors
• Triage resulting rework to appropriate staff, documenting and tracking contacts with members, providers, and plan sponsors
• Guide members through their plan of benefits, Aetna policy, and procedures, ensuring compliance with regulatory guidelines
• Create an emotional connection with members by understanding and engaging with them to champion their best health
• Take accountability for fully understanding members' needs, building trusting and caring relationships
• Anticipate customer needs, providing related information to answer unasked questions
• Use customer service threshold framework to make financial decisions to resolve member issues
• Explain members' rights and responsibilities in accordance with contract
• Process claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals via target system
• Educate providers on self-service options, assist with credentialing and re-credentialing issues
• Respond to requests from Aetna's Law Document Center regarding litigation, lawsuits, and extensive file review requests
• Assist in preparation of complaint trend reports and compiling claim data for customer audits
• Determine medical necessity, applicable coverage provisions, and verify member plan eligibility
• Handle incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management
• Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible
• Perform financial data maintenance as necessary
• Use applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries

Essential Qualifications

To be successful in this role, you must possess:

• Bilingual proficiency in English and Spanish (written and oral fluency)

Preferred Qualifications

While not required, the following qualifications are preferred:

• Customer service experience in a transaction-based environment, such as a call center or retail location, demonstrating empathy and compassion
• Ability to multi-task and accomplish workload efficiently
• Understanding of medical terminology
• Proficient oral and written communication skills
• Proficient with Microsoft Word and Outlook
• Ability to maintain accuracy and production standards
• Negotiation skills
• Technical skills
• Problem-solving skills
• Attention to detail and accuracy
• Analytical skills

Education

A High School diploma or GED equivalent is required for this role.

Pay Range

The typical pay range for this role is $17.00 - $29.88 per hour, depending on experience, education, geography, and other relevant factors.

Benefits and Perks

At CVS Health, we offer a comprehensive range of benefits and perks to support your well-being, career growth, and financial security. These include:

• Medical, dental, and vision benefits
• 401(k) retirement savings plan
• Employee Stock Purchase Plan
• Term life insurance plan
• Short-term and long-term disability benefits
• Well-being programs
• Education assistance
• Free development courses
• CVS store discount
• Discount programs with participating partners
• Paid Time Off (PTO) or vacation pay
• Paid holidays throughout the calendar year

Career Growth Opportunities

At CVS Health, we are committed to supporting your career growth and development. As a Bilingual Customer Service Representative, you will have opportunities to:

• Develop your skills and expertise in customer service, healthcare, and insurance
• Advance to leadership roles or specialized positions within the company
• Participate in training and development programs to enhance your knowledge and skills
• Contribute to innovative projects and initiatives that shape the future of healthcare

Work Environment and Company Culture

Our work environment is dynamic, supportive, and inclusive. We value diversity, equity, and inclusion, and we are committed to creating a workplace culture that is respectful, empathetic, and patient-centered. As a Bilingual Customer Service Representative, you will be part of a team that is passionate about delivering exceptional healthcare experiences and making a positive impact on our members' lives.

Conclusion

If you are a compassionate, empathetic, and customer-focused individual who is passionate about healthcare and making a difference in the lives of others, we invite you to apply for the Bilingual Customer Service Representative role at CVS Health. With your skills, experience, and bilingual proficiency, you will play a vital role in shaping the healthcare experience for our members and contributing to our mission of transforming healthcare. Apply now to join our team and embark on a rewarding career journey with CVS Health.