Inbound Outbound Queue Associate

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

- 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 (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 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. 

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

- Call center experience is preferred, 1-2 years 

- Prior authorization experience, 1-2 years 

- Associates degree, preferred 
- High School Diploma, GED or equivalent experience. 

Work from Home Requirements:

• You must have or be able to obtain a direct/hardwired internet connection to a modem/router within 7 feet of your computer and

a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite internet are not permitted.

• A quiet, secure and private designated home virtual work location, free from distractions, tidy and organized, compliant with CVS

Health and HIPAA guidelines, and allowing for uninterrupted work during work hours.

• Work-from-Home colleagues are required to work within the state and city where they have confirmed they currently live.

• The company will provide equipment (keyboard, monitor, computer, headset, etc.). All new hires should provide their own

workspace furniture (desk or standing desk, as this position would require you to be at your desk for extended periods of time).

• If hired, you will commit to obtaining required internet speeds and adhere to all Work From Home requirements.

Technical and Logistical Requirements:

• Device & System Navigation: Comfortable setting up and using multiple monitors and navigating multiple applications

simultaneously to streamline tasks and improve efficiency.

• Communication Tools: Ability to communicate on digital channels such as via email, calendar invites, Teams messaging, and

virtual meetings.

• Collaboration & Scheduling: Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) applications or

similar (Google Workspace).

• Systems Access & Security: Ability to Log in to secure systems (e.g., VPN, EHR portal), lock a computer screen when

unattended, manage strong passwords, and recognize suspicious emails or links.

• Troubleshooting & Support: Ability to resolve common technical issues independently, such as: restarting an application when

frozen, resolving internet connection issues, and contacting IT for unresolved technical issues.

• Future Growth: Openness to learning new skills in the future as the workplace environment evolves

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.