Inbound/Outbound Queue Associate, CVS Health

CVS Health

Location:
United States, Work At Home

Category:
Customer Service

Contract Type:
Employment contract

Salary:

17.00 - 31.30 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. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

Job Responsibility:

Supports comprehensive coordination of medical services including intake, screening and referrals to Aetna Medical Services Programs
Promotes/supports quality effectiveness of Healthcare Services
Performs intake of calls from members or providers regarding services via telephone, fax, EDI
Utilizes eTUMS and other 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, URAQ and/or 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, and Milliman Criteria
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 (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
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access

Additional Information:

Job Posted:
July 13, 2025

Expiration:
July 15, 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