Inbound/Outbound Queue Associate

Job not on LinkedIn

🔥 15 hours ago

🇺🇸 United States – Remote

💵 $17 - $25 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Coordinate medical services, including intake, screening, and referrals • Promote and support the quality effectiveness of Healthcare Services • Handle member and provider service requests via telephone, fax, and EDI • Build, research, and enter member information in Aetna systems • Screen requests for referral to medical services staff • Approve services that do not require medical review according to the benefit plan • Conduct eligibility, COB, and benefits verification research • Maintain accurate documentation meeting risk management, regulatory, and accreditation requirements • Communicate internally and externally with claim administrators, plan sponsors, third-party payers, members, families, and healthcare team members • Communicate with Aetna Case Managers, Nurses, and Medical Directors when processing member transactions • Support precertification processes in compliance with laws, regulations, NCQA standards, and company policies • Place outbound provider calls to provide information or obtain clinical information for medical authorization approval

🎯 Requirements

• 1-2 years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience • High School Diploma, GED or equivalent experience • Call center experience, 1-2 years preferred • Prior authorization experience, 1-2 years preferred • Associate degree preferred • Ability to perform sedentary work involving significant periods of sitting, talking, hearing, and keying • Visual acuity to inspect written and computer-generated documents and a PC monitor • Ability to use Aetna systems such as MedCompass, QNXT, ProFAX and ProPAT • Ability to protect confidential member information and follow company confidentiality policies

🏖️ Benefits

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