Inbound/Outbound Queue Associate

CVS Health Careers

. Support comprehensive coordination of medical services, including intake, screening, and referrals to Aetna Better Health .

Posted 10/30/2026full-timeRemote • Texas • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in coordinating medical services, including intake, screening, and referrals, while ensuring compliance with regulatory and accreditation standards. Proficient in managing member information and communication with healthcare professionals to facilitate effective service delivery.

Highest-signal resume keywords

Medical Services CoordinationPrior Authorization ExperienceCall Center ExperienceDocumentation ComplianceMember Information Confidentiality

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Intake ProcessingEligibility VerificationBenefits VerificationReferral ScreeningPrecertification Administration

Soft Skills

Effective CommunicationInterpersonal SkillsAttention to Detail

Tools & Technologies

Aetna SystemsEDI

Certifications & Qualifications

High School DiplomaGEDAssociates Degree

Industry Keywords

Healthcare ServicesRisk ManagementRegulatory ComplianceNCQA Standards

About the role

Key responsibilities & impact

Support comprehensive coordination of medical services, including intake, screening, and referrals to Aetna Better Health
Promote and support quality effectiveness of Healthcare Services
Perform intake of calls from members or providers regarding services via telephone, fax, and EDI
Use Aetna systems to build, research, and enter member information
Screen requests for appropriate referral from medical services staff
Approve services that do not require medical review in accordance with the benefit plan
Perform non-medical research, including eligibility, COB, and benefits verification
Maintain accurate and complete documentation meeting risk management, regulatory, and accreditation requirements
Promote internal and external communication with claim administrators, Plan Sponsors, third-party payers, members, families, and healthcare team members
Communicate with Aetna Case Managers, Nurses, and Medical Directors when processing member transactions
Support administration of the precertification process in compliance with applicable laws, regulations, NCQA standards, and company policies
Place outbound calls to providers to provide information or obtain clinical information for medical authorization approval
Work scheduled hours between 8am and 6pm EST, Monday through Friday

Requirements

What you’ll need

1-2 years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience
Call center experience preferred, 1-2 years
Prior authorization experience preferred, 1-2 years
High School Diploma, GED or equivalent experience
Associates degree preferred
Ability to protect the confidentiality of member information and adhere to company confidentiality policies
Ability to perform sedentary work involving significant periods of sitting, talking, hearing, and keying
Visual acuity to inspect written and computer-generated documents and a PC monitor

Benefits

Comp & perks

Medical coverage
Dental coverage
Vision coverage
Paid time off
Retirement savings options
Wellness programs
Other resources supporting physical, emotional, and financial well-being, based on eligibility
CVS Health bonus, commission or short-term incentive program eligibility