Top Aetna CVS Health Interview Questions and Answers

Aetna CVS Health is one of the nation’s leading diversified health services companies, serving over 34 million people. Since acquiring Aetna in 2018, CVS Health has continued to be an innovative industry leader improving access to care and lowering costs.

With a strong focus on human connection and customer experience, Aetna CVS Health aims to provide holistic care tailored to individual health needs. The company culture emphasizes integrity, collaboration, and inclusion.

This makes the interview process thorough, often involving multiple interviews evaluating both your customer service philosophy and relevant domain knowledge for the role. Preparing responses to common Aetna CVS Health interview questions can help you have an engaging discussion focused on how your skills align with the company’s vision and values

Here are some of the top questions frequently asked across various functions at Aetna CVS Health along with tips for crafting impressive responses

Customer Service Interview Questions

Customer obsession is integral to the Aetna CVS Health service culture. Expect questions assessing your patient focus communication skills and problem-solving abilities.

Q: How would you handle an unhappy customer or patient who is upset about a claim denial or coverage limitation?

Show empathy and conflict resolution skills by explaining how you would listen actively to understand their full situation, express regret for their dissatisfaction, review their plan details to clarify the rationale, offer available alternatives and resources, and escalate to a supervisor if needed to resolve the matter.

Q: Tell me about a time you had to explain a complex health insurance concept to a customer. How did you ensure they understood?

This demonstrates your ability to take complex information and simplify it for customer comprehension. Share how you used clear language, examples and analogies to illustrate points, verified understanding through teach-back questioning, and re-explained or connected them with experts if needed.

Q: What principles do you follow to deliver exceptional customer service and leave a lasting positive impression?

Highlight principles like personalizing interactions using their name, being fully present and attentive, providing solutions not excuses, following up on open issues proactively, owning any errors and making them right, and expressing genuine gratitude for the opportunity to assist.

Q: How do you balance showing empathy for a customer’s concerns while also following company protocols?

Acknowledge the need for compassion while explaining how you adhere to regulatory policies and plan provisions by listening deeply first, then educating tactfully on requirements, offering available alternatives, involving managers if needed, and expressing understanding throughout the process.

Q: Tell me about a time you had a very complex customer request. How did you handle it?

By outlining the specific situation, share how you actively listened, asked thoughtful follow-up questions, researched available resources and regulations, consulted knowledgeable teammates, and persevered to either resolve the request or explain next steps clearly while managing the customer’s expectations.

Q: You notice a colleague providing wrong information to a customer. What would you do?

Show integrity by stating that you would politely interrupt, provide the correct information immediately, pull your colleague aside to understand the context privately, offer guidance and resources for improvement, and escalate to a supervisor if misinformation persists despite coaching.

Healthcare Industry Knowledge

Aetna CVS Health assesses your understanding of the healthcare landscape, regulations, systems and terminology relevant to your role. Be ready to demonstrate your functional healthcare knowledge.

Q: Walk me through the typical flow of how a claim gets filed, processed and paid out.

Demonstrate your knowledge of insurance operations by outlining step-by-step how a provider submits a claim, how it gets processed against the member’s benefits for pricing, edits and eligibility checks, any additional research or coordination if issues arise, and finally claim settlement with provider payment and member cost details.

Q: What factors contribute to rising healthcare costs and how might an insurer aim to address these?

Show understanding of cost drivers like utilization trends, new technologies, chronic conditions, waste, fraud, lack of transparency and preventive care. Highlight solutions like value-based plans, preventive care incentives, pricing transparency tools, and data analytics to detect fraud patterns.

Q: What types of healthcare data would be useful for identifying individuals at risk for certain medical conditions?

Demonstrate knowledge of risk stratification data like demographics, diagnoses, procedures, lab results, prescriptions, vitals, family history and social determinants that could flag at-risk groups for proactive outreach and preventive interventions.

Q: What value does a pharmacy benefit manager like CVS Caremark provide in controlling prescription drug costs?

Highlight their role in negotiating savings through discounts and rebates with drug manufacturers, promoting use of lower-cost therapeutic alternatives through formulary management, and reducing pharmacy administration costs through efficient claims adjudication.

Q: In what ways does the Affordable Care Act impact how health insurance companies do business?

Show understanding of ACA provisions like guaranteed coverage, dependent coverage expansion, elimination of spending caps, pre-existing condition protections, health insurance exchanges, Medicaid expansion and premium subsidies that have influenced plan offerings, enrollments, and insurer regulations.

Q: What strategies help promote better consumer health engagement and medical treatment compliance?

Discuss tactics like consumer education on treatment plans, preventive care reminders, reducing cost barriers to care access, wellness incentives, gamification, social support communities, and leveraging data to identify care gaps proactively.

Situational Interview Questions

Hypothetical “what would you do” questions are commonly asked to assess judgment, ethics and safety awareness. Use your best judgment to respond appropriately.

Q: You notice a coworker breaking patient confidentiality protocols. How would you handle this?

Highlight acting promptly to stop the violation, reporting it immediately rather than confronting the co-worker yourself to follow policy, and emphasizing the critical importance of protecting patient privacy and health data security during the process.

Q: A processing error leads to overpayment of claims. How would you recommend Aetna CVS Health resolve this?

Demonstrate ethics by advising transparency, taking accountability for the error, collaborating cross-functionally to quantify the overpayments, establishing a streamlined provider repayment process, auditing to prevent recurrence, and communicating openly with affected members and providers.

Q: If a superior asks you to engage in unethical conduct that conflicts with company values, how would you respond?

Show integrity by stating that you would politely push back, explain your concerns about the implications for customers and the company’s reputation, suggest ethical alternatives, and refuse to act unethically while also escalating the matter through proper channels if needed.

Q: If you notice a compliance breach or regulatory violation, how would you act?

Convey vigilance and courage by stating that you would immediately report your observations through official channels, fully cooperate with investigations, and follow protocols to have the matter reviewed by legal/compliance teams to support resolution in line with laws and regulations.

With some practice tailoring your responses using healthcare examples and terminology, you can confidently answer these common Aetna CVS Health interview questions. Focus on conveying your customer service values, functional healthcare knowledge, ethics and good judgment to stand out as a top candidate. Wishing you the best with your Aetna CVS Health interview!