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Inbound/Outbound Queue Associate id-23954

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.

Schedule

  • Work schedule will be 4- 10-hour shifts Sat- Tuesday
  • During training will work 8 AM to 5 PM CST

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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 to medical services staff.
  • Approve 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, and third party payers as well as member, family, and health care team members respectively)
  • Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
  • Communicate 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 involving 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 is preferred, 1-2 years
  • Prior authorization experience, 1-2 years

Education

  • Associates degree, preferred
  • High School Diploma, GED or equivalent experience.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The Typical Pay Range For This Role Is

$17.00 - $25.65

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great Benefits For Great People

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

  • 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.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 05/05/2025

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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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

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2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

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5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

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This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...

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