Inbound/Outbound Queue Associate

CVS Health Careers

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

Posted 11/6/2026full-timeRemote • Oklahoma • United StatesJuniorMid-Level💰 $17 - $26 per hourWebsite

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 utilizing Aetna systems for member information management and maintaining confidentiality.

Highest-signal resume keywords

Medical Services CoordinationIntake and ScreeningAetna Systems ProficiencyPrior Authorization ExperienceCall Center Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Intake ProcessingEligibility VerificationBenefits VerificationDocumentation ManagementReferral ScreeningPrecertification AdministrationNon-Medical ResearchMember Information ManagementClinical Information GatheringRisk Management Compliance

Soft Skills

Effective CommunicationConfidentiality AdherenceInterpersonal SkillsTeam CollaborationCustomer Service Orientation

Tools & Technologies

MedCompassQNXTProFAXProPATEDI Systems

Certifications & Qualifications

High School DiplomaGEDAssociates Degree (Preferred)

Industry Keywords

Healthcare ServicesAetna Better HealthNCQA StandardsRisk ManagementRegulatory Compliance

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
Utilize Aetna systems to build, research, and enter member information
Screen requests for appropriate referral to medical services staff
Approve services that do not require medical review in accordance with the benefit plan
Perform non-medical research, including eligibility verification, 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
Protect member information confidentiality and adhere to company policies
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
Use Aetna systems including MedCompass, QNXT, ProFAX, and ProPAT
Perform sedentary work involving significant periods of sitting, talking, hearing, and keying
Use visual acuity for close inspection of written and computer-generated documents and PC monitors

Requirements

What you’ll need

1-2 years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience
Must reside in Oklahoma
Able to work in a 24/7 center and work 40 hours each week
High School Diploma, GED or equivalent experience
Call center experience preferred, 1-2 years
Prior authorization experience preferred, 1-2 years
Associates degree preferred

Benefits

Comp & perks

CVS Health bonus, commission or short-term incentive program
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