Inbound/Outbound Queue Associate

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

📋 Description

• Assist with the comprehensive coordination of medical services, encompassing intake, screening, and referrals.

• Advocate for and enhance the quality effectiveness of Healthcare Services.

• Handle intake of member or provider inquiries regarding services through telephone, fax, and EDI.

• Utilize Aetna systems to create, investigate, and input member information.

• Evaluate requests for proper referral to medical services personnel.

• Authorize services that do not necessitate medical review in line with the benefit plan.

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

• Ensure accurate and complete documentation that adheres to risk management, regulatory, and accreditation standards.

• Facilitate internal and external communication with claim administrators, Plan Sponsors, third-party payers, members, families, and healthcare team members.

• Safeguard member information confidentiality and adhere to company confidentiality policies.

• Liaise with Aetna Case Managers, Nurses, and Medical Directors when processing relevant member transactions.

• Assist with precertification administration in accordance with laws, regulations, and/or NCQA standards.

• Make outbound provider calls to share information or gather clinical details for medical authorization approvals.

• Employ Aetna systems, including MedCompass, QNXT, ProFAX, and ProPAT.

• Engage in sedentary work that involves extended periods of sitting, talking, hearing, and typing.

• Review written and computer-generated documents and information displayed on PC monitors.

⛳️ Requirements

• 1-2 years of experience as a medical assistant, office assistant, or in a similar clinical role.

• High School Diploma, GED, or equivalent experience.

• Capability to secure a direct/hardwired internet connection to a modem/router within 7 feet of the computer.

• Minimum internet speed of 25 Mbps for download and 3 Mbps for upload.

• WiFi and satellite internet are not acceptable.

• A designated home virtual work location that is quiet, secure, and private, compliant with CVS Health and HIPAA guidelines.

• Must operate within the state and city of current residence.

• Responsible for providing workspace furniture, such as a desk or standing desk.

• Proficient in setting up and utilizing multiple monitors and navigating multiple applications simultaneously.

• Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings.

• Experience with Microsoft Office 365 (Teams, Outlook, Word, Excel, PowerPoint) or similar Google Workspace applications.

• Ability to log in to secure systems such as VPN and EHR portals.

• Familiarity with computer security practices, including screen locking, strong password management, and identifying suspicious emails or links.

• Capability to independently resolve common technical issues.

• Willingness to learn new skills as workplace dynamics evolve.

• An associate's degree is preferred.

• Call center experience of 1-2 years is preferred.

• Prior authorization experience of 1-2 years is preferred.

🏝️ Benefits

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

• Medical coverage.

• Dental coverage.

• Vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources based on eligibility.

• Company-provided equipment (keyboard, monitor, computer, headset, etc.).