Inbound/Outbound Queue Associate
Role Overview
Work schedule between 8am-6pmEST; no weekends. - 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 from 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/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 involves 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.
Full Job Posting
Position Summary
Work schedule between 8am-6pmEST; no weekends. - 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 from 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/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 involves 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.
Required Qualifications
- - 1-2 years' experience working as a medical assistant, office assistant or other clinical/equivalent experience.
Preferred Qualifications
- - Call center experience is preferred, 1-2 years - Prior authorization experience, 1-2 years Education - Associates degree, preferred. - High School Diploma, GED or equivalent experience. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is $17.00 - $31.30 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments ( https://learn.bswift.com/cvshealth-mainland ) . We anticipate the application window for this opening will close on 11/05/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. CVS Health is an equal opportunity/affirmative action employer, including Disability/Protected Veteran - committed to diversity in the workplace.
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