**Experienced Senior Customer Service Representative – Transforming Healthcare through Compassionate Support**

Are you passionate about delivering exceptional customer experiences and making a meaningful impact in the lives of others? Do you thrive in a dynamic, fast-paced environment where no two days are ever the same? If so, we invite you to join blithequark's Meritain Health team as a Senior Customer Service Representative. In this pivotal role, you will be the face of our organization, providing empathetic and compassionate support to our members, providers, and plan sponsors. **About blithequark** At blithequark, we are committed to revolutionizing the healthcare industry by delivering personalized, convenient, and affordable solutions that put our members at the forefront. Our purpose is simple: to bring our heart to every moment of your health. We believe that every interaction, every conversation, and every decision we make has the power to transform lives. As a Senior Customer Service Representative, you will be an integral part of this mission, working collaboratively with our team to create a culture of empathy, understanding, and excellence. **Work Environment and Culture** As a work-from-home Senior Customer Service Representative, you will enjoy the flexibility and autonomy to work from the comfort of your own home. Our team is dedicated to fostering a culture of inclusivity, respect, and open communication. We believe that every individual brings unique perspectives and experiences to the table, and we strive to create an environment that celebrates diversity and promotes growth. **Key Responsibilities** As a Senior Customer Service Representative, you will be responsible for: * Handling customer service inquiries and problems via telephone, internet, or written correspondence * Answering questions and resolving issues based on phone calls/letters from members, providers, and plan sponsors * Triaging resulting rework to appropriate staff * Documenting and tracking contacts with members, providers, and plan sponsors * Guiding members through their plan of benefits, Aetna policy, and procedures * Creating an emotional connection with our members by understanding and engaging with them to champion their best health * Anticipating customer needs and providing related information to answer unasked questions * Using customer service threshold framework to make financial decisions to resolve member issues * Explaining member's rights and responsibilities in accordance with contract * Processing claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals via target system * Educating providers on our self-service options and assisting with credentialing and re-credentialing issues * Responding to requests received from Aetna's Law Document Center regarding litigation and lawsuits * Assisting in preparation of complaint trend reports and compiling claim data for customer audits * Determining medical necessity, applicable coverage provisions, and verifying member plan eligibility relating to incoming correspondence and internal referrals * Handling incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management * Performing review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible * Performing financial data maintenance as necessary * Using applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received **Essential Qualifications** * Customer service experience in a transaction-based environment, such as a call center or retail location, demonstrating ability to be empathetic and compassionate * Experience in a production environment * High school diploma, GED, or equivalent experience **Preferred Qualifications** * Bachelor's degree in a related field (e.g., business, communications, healthcare) * Experience working in a healthcare or insurance environment * Certification in customer service or a related field (e.g., Certified Customer Service Representative (CCSR)) **Skills and Competencies** * Excellent communication and interpersonal skills * Ability to work in a fast-paced, dynamic environment * Strong problem-solving and analytical skills * Ability to work independently and as part of a team * Proficiency in Microsoft Office and other software applications * Ability to learn and adapt to new systems and processes * Strong attention to detail and organizational skills * Ability to maintain confidentiality and handle sensitive information **Career Growth Opportunities and Learning Benefits** At blithequark, we are committed to investing in our employees' growth and development. As a Senior Customer Service Representative, you will have access to: * Ongoing training and development opportunities to enhance your skills and knowledge * Mentorship and coaching from experienced team members * Opportunities for career advancement and professional growth * Access to blithequark's comprehensive benefits package, including medical, dental, and vision benefits, 401(k) retirement savings plan, and employee stock purchase plan * Paid time off and holidays * A dynamic and supportive work environment that encourages collaboration and innovation **Compensation and Perks** As a Senior Customer Service Representative, you will be eligible for a competitive hourly rate of $18.50-$31.72, depending on experience and qualifications. In addition to your base salary, you will also be eligible for a CVS Health bonus, commission, or short-term incentive program. Our comprehensive benefits package includes: * Medical, dental, and vision benefits * 401(k) retirement savings plan * Employee stock purchase plan * Paid time off and holidays * A fully-paid term life insurance plan * Short-term and long-term disability benefits * Well-being programs, education assistance, and free development courses * CVS store discount and discount programs with participating partners **How to Apply** If you are passionate about delivering exceptional customer experiences and making a meaningful impact in the lives of others, we invite you to apply for this exciting opportunity. Please visit our website to submit your application and join our team of dedicated professionals who are transforming the healthcare industry one interaction at a time. **Application Deadline** We anticipate the application window for this opening will close on November 25, 2024. Don't miss this opportunity to join blithequark's Meritain Health team and make a difference in the lives of our members, providers, and plan sponsors. **Equal Employment Opportunity** blithequark is an equal employment opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive and respectful work environment that celebrates diversity and promotes growth. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. Apply for this job