Customer Service Representative, Operations

Call Center 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.

The Call Center Representative serves as the primary point of contact for members, providers, and plan sponsors, delivering exceptional customer service through phone, digital, and written communication channels. This role is responsible for resolving inquiries, educating customers on benefits and available resources, advocating for customer needs, and creating positive service experiences. The representative demonstrates strong problem-solving skills, professionalism, empathy, and accountability while ensuring compliance with company policies and regulatory requirements.

This position operates on a hybrid work schedule, combining remote and in-office work. The representative must effectively manage responsibilities in both environments, maintain productivity and service standards, and adhere to all company policies related to attendance, security, and customer confidentiality.

Key Responsibilities

• Respond to member, provider, and plan sponsor inquiries through telephone, chat, email, and written correspondence.
• Resolve routine and complex customer concerns while delivering a high-quality customer experience.
• Accurately document customer interactions and maintain detailed records in applicable systems.
• Educate customers on plan benefits, policies, procedures, and self-service tools.
• Identify customer needs through active listening and provide personalized solutions and recommendations.
• Research and resolve claims, eligibility, billing, enrollment, and benefit-related issues.
• Coordinate escalations and referrals to appropriate departments when necessary.
• Demonstrate ownership of customer concerns through first-call resolution whenever possible.
• Maintain productivity, quality, compliance, and customer satisfaction standards.
• Support appeals, grievances, complaints, and authorization-related inquiries according to established guidelines.
• Utilize multiple systems and resources to investigate issues and provide accurate information.
• Adhere to HIPAA, regulatory requirements, and company policies regarding privacy and confidentiality.
• Participate in training, coaching, and continuous improvement initiatives.
• Contribute to a positive team environment by sharing knowledge and supporting organizational goals.

Required Qualifications

• Minimum one year of customer service, call center, healthcare, insurance, or related experience preferred.
• Able to work a hybrid schedule 3 days a week.
• Ability to navigate multiple systems while speaking with customers.
• Demonstrated problem-solving, critical thinking, and decision-making abilities.
• Ability to manage competing priorities in a fast-paced environment.
• Proficiency with Microsoft Office and customer relationship management systems.

Preferred Qualifications

• Experience in healthcare, insurance, or benefits administration.
• Knowledge of claims, eligibility, appeals, and authorization processes.
• Experience supporting customers through multiple communication channels, including phone, chat, and email.
• Strong verbal and written communication skills.
• Strong attention to detail and organizational skills.
• Bilingual skills preferred where applicable.

Education

• High school diploma or GED equivalent

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $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.

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.