Inbound Outbound Que Associate -4

CVS Health Job Opportunity

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.

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 from 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 involves 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 :

Preferred Qualifications :

Education :

Anticipated Weekly Hours : 40

Time Type : Full time

Pay Range : The typical pay range for this role is : $17.00 - $34.15. 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.

Great benefits for great people :

We anticipate the application window for this opening will close on : 11 / 27 / 2025. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. We are an equal opportunity and affirmative action employer.