[Hiring] Senior Integrated Service Specialist @CVS Health

Role Description

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.

• 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.

Qualifications

• 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.

Requirements

• Experience in a metric-based environment is a plus.
• High school diploma or GED required.

Benefits

• Comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families.
• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources, based on eligibility.