Inbound/Outbound Queue Associate, CVS Health

CVS Health

Location:
United States, Virginia

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. Promotes/supports quality effectiveness of Healthcare Services, processes member or provider service requests, and adheres to confidentiality policies while utilizing Aetna systems to manage information.

Job Responsibility:

Promotes/supports quality effectiveness of Healthcare Services
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 that meets risk management, regulatory, and accreditation requirements
Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., claim administrators, Plan Sponsors, and third party payers as well as member, family, and health care team members respectively)
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, and NCQA standards, where applicable, while adhering to company policy and procedures
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
Sedentary work involving significant periods of sitting, talking, hearing and keying
Work requires visual acuity to perform close inspection of written and computer-generated documents as well as a PC monitor
Working environment includes typical office conditions

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 including matching company contributions
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 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

Additional Information:

Job Posted:
August 26, 2025

Expiration:
September 08, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Inbound/Outbound Queue Associate

CVS Health

Location:United States, Virginia

Category:Customer Service

Contract Type:Employment contract