Inbound/Outbound Queue Associate, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Customer Service

Contract Type:
Employment contract

Salary:

17.00 - 28.46 USD / Hour

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Job Description:

Supports comprehensive coordination of medical services including intake, screening and referrals to Aetna Medical Services Programs. Schedule is Sunday through Thursday, 1pm-10pm EST.

Job Responsibility:

Supports comprehensive coordination of medical services including intake, screening and referrals to Aetna Medical Services Programs
Performs intake of calls from members or providers regarding services via telephone, fax, EDI
Utilizes Aetna systems to build, research and enter member information
Screens requests for appropriate referral to medical services staff
Approve services that do not require a medical review in accordance with the benefit plan
Performs non-medical research including eligibility verification, COB, and benefits verification
Maintains accurate and complete documentation of required information
Promotes communication, both internally and externally to enhance effectiveness of medical management services
Protects the confidentiality of member information and adheres to company policies regarding confidentiality
Communicate with Aetna Case Managers, when processing transactions for members active in this Program
Supports the administration of the precertification process in compliance with various laws and regulations
Places outbound calls to providers under the direction of Medical Management Nurses to obtain clinical information for approval of medical authorizations
Uses Aetna Systems such as QNXT, ProFAX, ProPAT, Faxhub and MedCompass
Communicates with Aetna Nurses and Medical Directors, when processing transactions for members active in this Program

Requirements:

2-4 years experience as a medical assistant, office assistant or other clinical experience
High School diploma or equivalent GED

What we offer:

Affordable medical plan options
401(k) plan with matching company contributions
Employee stock purchase plan
Wellness screenings
Tobacco cessation programs
Weight management programs
Confidential counseling
Financial coaching
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
September 04, 2025

Expiration:
September 10, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Inbound/Outbound Queue Associate

CVS Health

Location:United States, Work At Home

Category:Customer Service

Contract Type:Employment contract