Customer Service Representative

CVS Health

. Serve as the primary point of contact for members, providers, and plan sponsors .

Posted 10/2/2026full-timeFranklin • Tennessee • United StatesMid-LevelSenior💰 $17 - $28 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in customer service within healthcare and insurance environments, effectively resolving complex issues while adhering to HIPAA and regulatory standards. Proficient in utilizing multiple systems for claims, eligibility, and benefits administration, with strong communication and organizational skills.

Highest-signal resume keywords

Customer Service ExperienceHealthcare KnowledgeClaims ResolutionMicrosoft Office ProficiencyBilingual Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingEligibility VerificationBenefits AdministrationProblem-SolvingDecision-Making

Soft Skills

Strong Communication SkillsAttention to DetailOrganizational SkillsCritical Thinking

Tools & Technologies

Customer Relationship Management SystemsDigital Communication Tools

Certifications & Qualifications

High School DiplomaGED Equivalent

Industry Keywords

HIPAA ComplianceCustomer SatisfactionCall Center ExperienceInsurance IndustryHealthcare Industry

About the role

Key responsibilities & impact

Serve as the primary point of contact for members, providers, and plan sponsors
Deliver customer service through phone, digital, and written communication channels
Resolve routine and complex customer concerns
Document customer interactions and maintain detailed records
Educate customers on plan benefits, policies, procedures, and self-service tools
Identify customer needs and provide personalized solutions and recommendations
Research and resolve claims, eligibility, billing, enrollment, and benefit-related issues
Coordinate escalations and referrals to appropriate departments
Pursue first-call resolution whenever possible
Maintain productivity, quality, compliance, and customer satisfaction standards
Support appeals, grievances, complaints, and authorization-related inquiries
Use multiple systems and resources to investigate issues and provide accurate information
Adhere to HIPAA, regulatory requirements, and privacy and confidentiality policies
Participate in training, coaching, and continuous improvement initiatives
Share knowledge and support organizational goals

Requirements

What you’ll need

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
Experience in healthcare, insurance, or benefits administration preferred
Knowledge of claims, eligibility, appeals, and authorization processes preferred
Experience supporting customers through phone, chat, and email preferred
Strong verbal and written communication skills
Strong attention to detail and organizational skills
Bilingual skills preferred where applicable
High school diploma or GED equivalent

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Comprehensive benefits package supporting physical, emotional, and financial well-being
Training, coaching, and continuous improvement initiatives