Senior Integrated Service Specialist

Senior Integrated Service Specialist

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 Senior Integrated Service Specialist serves as the primary point of contact for customers seeking assistance with claims-related inquiries. This role is responsible for providing clear and accurate information regarding claims submissions, status updates, denial reasons, and payment or reimbursement issues. The specialist also facilitates referrals to in-network healthcare providers and contributes to service improvement initiatives.

What you will do:

• Executes both routine and non-routine business support tasks for the Integrated Services area under limited supervision, referring deviations from standard practices to managers.
• Follows area protocols, standards, and policies to provide effective and timely support.
• Interfaces with clients and providers via telephone, fax, electronic mail to identify and resolve member needs through analysis and evaluation of information and solutions.
• Researches and updates information using internal systems and resources to resolve enrollment and accounts receivable questions and to process claims and adjustments.
• Manages work distribution including client inquiries via work queues, monitoring, and adjusting workflow accordingly for load balance purposes.
• Takes direction to execute techniques, processes, and responsibilities.

Required Qualification:

• 3 years of customer service experience required.
• 2-3 years of claims processing experience.
• 2-3 years of client support experience.
• Proficiency in Microsoft Word and Excel is required; analytical experience with the ability to interpret data and make informed decisions is essential.

Preferred Qualification:

• Experience in a metric-based environment is a plus.

Education:

• High school diploma or GED required.

Anticipated Weekly Hours: 40

Time Type: Full time

Pay Range: $18.50 - $35.29

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 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.