Inbound/Outbound Queue Associate

This is a fully remote position, open to applicants in Arizona.

📋 Description

• Handle incoming calls from facilities, providers, and members concerning pre-certification related to Medicare and Commercial Insurance.

• Conduct intake of calls from members or providers about services through telephone, fax, and EDI.

• Evaluate requests for proper referral to medical services personnel.

• Authorize services not requiring medical review in accordance with the benefit plan.

• Carry out non-medical research, including eligibility checks, COB, and benefits verification.

• Ensure accurate and thorough documentation that meets risk management, regulatory, and accreditation standards.

• Safeguard the confidentiality of member information and comply with company confidentiality policies.

• Coordinate with Aetna Case Managers when managing transactions for members enrolled in the program.

• Execute additional duties and responsibilities as needed.

⛳️ Requirements

• Minimum of 1 year of experience in Customer Service.

• At least 1 year of experience in a Call Center environment.

• Must possess high-speed internet and a secure workspace.

• High School Diploma or equivalent GED required.

• Understanding of basic medical terminology and concepts utilized in care management.

• 2-4 years of experience as a medical assistant, office assistant, or in other clinical roles.

• Strong communication, telephonic, and organizational skills.

• Excellent customer service abilities.

• Proficiency in computer applications, including Excel and Microsoft Word.

• Capability to effectively engage in a multi-disciplinary team involving both internal and external participants.

• Availability from Monday to Friday, 12:00pm-8:30pm EST.

• Training required Monday to Friday, 10:00am-6:30pm ET, for the initial 8 weeks.

• Willingness to work some holidays, as the department operates 365 days a year.

🏝️ Benefits

• CVS Health bonus, commission, or short-term incentive program in addition to base salary.

• Medical insurance coverage.

• Dental insurance coverage.

• Vision insurance coverage.

• Paid time off.

• Retirement savings plans.

• Wellness initiatives.

• Additional resources that support physical, emotional, and financial well-being.

• Option for remote work arrangement.