Inbound/Outbound Queue Associate

CVS Health

. Support comprehensive coordination of medical services, including intake, screening, and referrals .

Posted 10/30/2026full-timeRemote • Ohio • United StatesJuniorMid-Level💰 $17 - $31 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 effective communication with healthcare team members.

Highest-signal resume keywords

Medical Services CoordinationPrior Authorization ExperienceAetna Systems ProficiencyCall Center ExperienceDocumentation Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Intake CoordinationEligibility VerificationBenefits VerificationReferral ScreeningMedical DocumentationPrecertification AdministrationNon-Medical ResearchMember Information Management

Soft Skills

Effective CommunicationConfidentiality ProtectionInterpersonal Skills

Tools & Technologies

MedCompassQNXTProFAXProPAT

Certifications & Qualifications

High School DiplomaGEDAssociates Degree (Preferred)

Industry Keywords

Healthcare ServicesRisk ManagementRegulatory ComplianceNCQA StandardsThird-Party Payers

About the role

Key responsibilities & impact

Support comprehensive coordination of medical services, including intake, screening, and referrals
Promote and support quality effectiveness of Healthcare Services
Perform intake of calls from members or providers via telephone, fax, and EDI
Utilize 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 according to 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
Protect member information confidentiality and follow 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

Requirements

What you’ll need

1-2 years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience
High School Diploma, GED or equivalent experience
Call center experience preferred, 1-2 years
Prior authorization experience preferred, 1-2 years
Associates degree preferred
Ability to work between 8am-6pm EST
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

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