Medicaid Provider Customer Service Representative

CVS Health • Frankfort, KY • 2d ago

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Position Summary

Answer questions and resolves issues based on phone calls/letters from providers. Triage resulting rework to appropriate staff.

Provide excellent customer services for high volume inbound provider calls for the Claims Inquiry/Claims Research Medicaid team. Extensive claims research on multiple platforms to assist providers with payment questions.

Educate provider with related information to answer the unasked questions, e.g., additional plan details, benefit plan details, provider self-service tools, etc.

Use customer service threshold framework to make financial decisions to resolve provider issues. Explain provider's rights and responsibilities in accordance with contract.

Process claim referrals, new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system.

Assists providers with credentialing/re-credentialing and contracting questions and issues.

Assist in compiling claim data for audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal referrals.

Work hours will be between 7am to 7pm local time, Monday through Friday, and can vary periodically throughout the year. Advance notice will be given if schedules are changed.

Required Qualifications

Familiarity with Microsoft Office products such as OneNote, Outlook, Word, Teams, Excel

Ability to maneuver through multiple system applications to gather information while on a call

Excellent customer service and critical thinking is a must

Must secure high speed internet access ( 100 mbps or higher ) with consistent, stable connection. A speed test will be required to proceed with an interview.

Work location must be set up with a direct connection to the router (NOT Wi-Fi). We provide a 6 ½ foot long ethernet cord, if the distance is further, you will be required to provide your own ethernet cable.

Private workspace that is secure, quiet, and uninterrupted, and that allows appropriate maintenance of confidentiality as required by HIPAA and CVS Health guidelines.

Preferred Qualifications

Healthcare background

Experience in highly transactional call center environment

Education

High School diploma or GED equivalent.

Anticipated Weekly Hours

Time Type

Full time

The hours listed below are the required availability for this role. Please only apply if you can meet these schedule requirements.

Shift Flexibility:

Monday: -

Tuesday: -

Wednesday: -

Thursday: -

Friday: -

Saturday: -

Sunday: -

Weekend Shift Frequency:

Language

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.

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 our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan .

No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 10/03/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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