Inbound/Outbound Queue Associate

Job not on LinkedIn

🔥 4 minutes ago

🌪️ Oklahoma – Remote

🌪️ Oklahoma – Remote

💵 $17 - $25 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Support comprehensive coordination of medical services, including intake, screening, and referrals to Aetna Better Health • Promote and support quality effectiveness of Healthcare Services • Perform intake of calls from members or providers regarding services via telephone, fax, and EDI • Utilize Aetna systems to build, research, and enter member information • Screen requests for appropriate referral to medical services staff • Approve services that do not require medical review in accordance with the benefit plan • Perform non-medical research, including eligibility verification, COB, and benefits verification • Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements • Promote internal and external communication with claim administrators, Plan Sponsors, third-party payers, members, families, and healthcare team members • Protect member information confidentiality and adhere to company policies • Communicate with Aetna Case Managers, Nurses, and Medical Directors when processing member transactions • Support administration of the precertification process in compliance with applicable laws, regulations, NCQA standards, and company policies • Place outbound calls to providers to provide information or obtain clinical information for medical authorization approval • Use Aetna systems including MedCompass, QNXT, ProFAX, and ProPAT • Perform sedentary work involving significant periods of sitting, talking, hearing, and keying • Use visual acuity for close inspection of written and computer-generated documents and PC monitors

🎯 Requirements

• 1-2 years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience • Must reside in Oklahoma • Able to work in a 24/7 center and work 40 hours each week • High School Diploma, GED or equivalent experience • Call center experience preferred, 1-2 years • Prior authorization experience preferred, 1-2 years • Associates degree preferred

🏖️ Benefits

• CVS Health bonus, commission or short-term incentive program • Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being, based on eligibility

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