Inbound/Outbound Queue Associate

CVS Health

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

Posted 10/1/2026full-timeRemote • Kentucky • United StatesJuniorMid-Level💰 $17 - $31 per hourWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in coordinating medical services, including intake, screening, and referrals, while ensuring compliance with regulatory and accreditation standards. Proficient in using healthcare systems for member information management and communication with healthcare teams.

Highest-signal resume keywords

Medical Services CoordinationIntake and ScreeningPrior Authorization ExperienceAetna Systems ProficiencyRegulatory Compliance

ATS Keywords

Tailor your resume

Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Intake ProcessingEligibility VerificationBenefits VerificationReferral ManagementDocumentation Accuracy

Soft Skills

Effective CommunicationConfidentiality AdherenceTeam Collaboration

Tools & Technologies

MedCompassQNXTProFAXProPAT

Certifications & Qualifications

High School DiplomaGEDAssociates Degree (Preferred)

Industry Keywords

Healthcare ServicesCall Center ExperienceRisk ManagementNCQA StandardsClinical Experience

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 member and provider calls regarding services via telephone, fax, and EDI
Use 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 according to the benefit plan
Perform non-medical research, including eligibility, COB, and benefits verification
Maintain accurate 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 confidentiality and follow company confidentiality policies
Communicate with Aetna Case Managers, Nurses, and Medical Directors when processing member transactions
Support precertification administration in compliance with laws, regulations, NCQA standards, and company procedures
Place outbound calls to providers to provide information or obtain clinical information for medical authorization approval
Use MedCompass, QNXT, ProFAX, and ProPAT systems

Requirements

What you’ll need

1-2 years experience working as a medical assistant, office assistant or other clinical/equivalent experience
1-2 years call center experience
High School Diploma, GED or equivalent experience
Sedentary work involving significant periods of sitting, talking, hearing, and keying
Visual acuity to perform close inspection of written and computer-generated documents and a PC monitor
Associates degree, preferred
Prior authorization experience, 1-2 years, preferred

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
CVS Health bonus, commission or short-term incentive program in addition to base pay