Customer Service Representative - Behavioral Health

Job description

Customer Service Representative 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. Job Summary: CVS Aetna has an opportunity available for a full-time Customer Service Representative aligned with the Behavioral Health team. This role provides advocate care to assist the member with a clear path to care, claims understanding/resolution, and member education around online resources. The Customer Service Representative guides the members through their members' benefit plans and Aetna policy/procedures. They will also be expected to have knowledge of regulatory guidelines governing these resources. The Customer Service Representative position is ideal for someone with strong interpersonal skills, a passion for mental wellness advocacy, and is comfortable working with digital platforms in a fast-paced and emotionally sensitive setting. Training Schedule: • Monday–Friday, 10:00 AM–6:30 PM EST • Duration: 8 weeks Available Work Schedules (Post‑Training): • Midday Shifts: • Monday–Friday, 10:30 AM–6:00 PM EST • Monday–Friday, 11:00 AM–7:00 PM EST • Evening Shift: • Monday–Friday, 11:45 AM–8:15 PM EST Key Responsibilities: • Takes inbound calls from members and determines the quickest, most effective ways to answer member questions. • Creates an emotional connection with members by understanding and engaging them to champion their best health. • Records within the overall member management system • Provides introductory information and connects members with additional and appropriate benefits/external resources. • Performs a review of members' claim history to ensure accurate tracking of benefit maximums, including deductible and coinsurance levels. • Explains members' rights and responsibilities in accordance with our plan sponsors' contracts. • Sends outbound e-mails to members where and as needed. • Supports members with troubleshooting and deescalating where needed. • Escalates queries and concerns when it is deemed necessary. • Ensures that members are satisfied with products/services by handling complaints and inquiries. • Works with the customer service team to share solutions and processes. • Embodies the CVS Core values in each interaction. Required Qualifications: • 1-3 years of call center and/or customer service experience. • 1-3 years of healthcare and/ or medical insurance experience. • Basic computer knowledge and technical skills to use IP phones, customer records management, word processing, database, and e-mail/chat programs. • A private and confidential workspace free from distractions. • A hardwired connection is required (i.e., an Ethernet connection). • Time management skills to promptly respond to e-mails, call, and chat messages. • Active listening skills to effectively handle members who may be upset. Preferred Qualifications: • Background in mental health or human services. • Bilingual or multilingual skills. • Experience working from home in a remote role. Educational Requirements: • A high school diploma or equivalent is required. • Associates degree preferred. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $17.00 - $25.65 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. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. We anticipate the application window for this opening will close on: 07/24/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.