CVS Health
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Inbound Outbound Queue Associate
role at
CVS Health .
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.
Position Summary
Supports comprehensive coordination of medical services including intake, screening, and referrals to Aetna Better Health.
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.
Approves 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, third‑party payers, member, family, and health care team members).
Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
Communicates 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, 1‑2 years.
Prior authorization experience, 1‑2 years.
Education
Associate’s degree, preferred.
High School Diploma, GED or equivalent experience.
Anticipated Weekly Hours
40
Time Type
Full time
The Typical Pay Range For This Role Is
$17.00 – $28.46
Great Benefits For Great People
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an 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 that address the different needs and preferences of our colleagues 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.
We anticipate the application window for this opening will close on: 01/13/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
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Inbound Outbound Queue Associate
role at
CVS Health .
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.
Position Summary
Supports comprehensive coordination of medical services including intake, screening, and referrals to Aetna Better Health.
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.
Approves 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, third‑party payers, member, family, and health care team members).
Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
Communicates 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, 1‑2 years.
Prior authorization experience, 1‑2 years.
Education
Associate’s degree, preferred.
High School Diploma, GED or equivalent experience.
Anticipated Weekly Hours
40
Time Type
Full time
The Typical Pay Range For This Role Is
$17.00 – $28.46
Great Benefits For Great People
Affordable medical plan options, a 401(k) plan (including matching company contributions), and an 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 that address the different needs and preferences of our colleagues 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.
We anticipate the application window for this opening will close on: 01/13/2026
Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.
#J-18808-Ljbffr