Inbound/Outbound Queue Associate, CVS Health

CVS Health

Location:
United States

Category:
Customer Service

Contract Type:
Employment contract

Salary:

17.00 - 25.65 USD / Hour

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Job Description:

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

Job Responsibility:

Supports comprehensive coordination of medical services including intake, screening, and referrals
Promotes/supports quality effectiveness of Healthcare Services
Performs intake of calls from members or providers regarding services via telephone, fax, EDI
Utilizes Aetna system 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
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/or NCQA standards, where applicable, while adhering to company policy and procedures
Places outbound calls to providers to provide information or obtain clinical information for approval of medical authorizations
Uses Aetna Systems such as MedCompass, QNXT, ProFAX and ProPAT
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

Requirements:

1-2 years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience
High School Diploma, GED or equivalent experience

Nice to have:

Call center experience, 1-2 years
Prior authorization experience, 1-2 years
Associates degree

What we offer:

Affordable medical plan options
401(k) plan including matching company contributions
Employee stock purchase plan
No-cost programs including wellness screenings, tobacco cessation and weight management programs, confidential counseling and 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:
October 31, 2025

Expiration:
November 15, 2025

Employment Type:

Fulltime

Work Type:

Remote work

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Inbound/Outbound Queue Associate