[Hiring] Inbound Outbound Que Associate @CVS Health

Role Description

This role supports medical prior authorization (precertification) operations by:

• Taking inbound calls from members and providers
• Building cases in multiple systems
• Ensuring accurate documentation and HIPAA-compliant handling of PHI/PII

Ideal candidates bring experience in a health insurance environment, familiarity with medical terminology and clinical workflows, and confidence working in a technology-driven, multi-system setting.

This is a fully remote from home position.

Training Schedule: Monday through Friday 9am to 5:30pm local time (no time off during 9 week training)

Post Training Work Schedule: Monday through Friday 11:30am - 8pm ET

Qualifications

• 1+ year of customer service/call center experience (healthcare, health insurance, or medical office preferred)
• Familiarity with health insurance concepts and workflows (e.g., prior authorization/precertification, utilization management, benefits, claims terminology)
• Working knowledge of HIPAA privacy practices and ability to handle PHI/PII appropriately
• Comfort navigating multiple computer applications at once (case tools/CRM, web portals) with accurate, fast data entry
• Strong verbal communication, active listening, documentation, and de-escalation skills
• Must be on camera during training

Requirements

• 1+ year in a health plan, utilization management, prior authorization, or provider services environment (preferred)
• Clinical or medical office background (e.g., medical assistant, medical office assistant, patient access, referrals/prior auth coordinator)
• Experience working with provider portals, EHR/EMR systems, or authorization/case management platforms
• Understanding of common medical codes and terminology (e.g., CPT/HCPCS/ICD-10) and ability to collect the correct clinical documentation (as applicable to the role)
• Familiarity with job aides/process flows including AI assisted features

Benefits

• Comprehensive medical, dental, and vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources based on eligibility

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.