[Hiring] Inbound Outbound Queue Associate @CVS Health

Role Description

Inbound Queue Associate - Behavioral Health role is responsible for accepting inbound calls from facilities, providers, and members regarding pre-certification process within Medicare and Commercial Insurance.

• Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
• 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.
• 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.
• Other duties and responsibilities as required.

Qualifications

• 1+ years of Customer Service Background
• 1+ years of Call Center experience
• Must have high speed internet and a secure working space

Requirements

• Familiarity with basic medical terminology and concepts used in care management.
• 2-4 years experience as a medical assistant, office assistant or other clinical experience.
• Effective communication, telephonic and organization skills.
• Strong customer service skills to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
• Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.
• Ability to effectively participate in a multi-disciplinary team including internal and external participants.

Benefits

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