Inbound/Outbound Queue Associate

CVS Health

. Accept inbound calls from facilities, providers, and members regarding pre-certification within Medicare and Commercial Insurance .

Posted 10/28/2026full-timeRemote • Arizona • United StatesJuniorMid-Level💰 $17 - $28 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates strong customer service and communication skills while effectively managing inbound calls related to pre-certification in Medicare and Commercial Insurance. Proficient in maintaining documentation and adhering to confidentiality policies within a multi-disciplinary team environment.

Highest-signal resume keywords

Customer Service ExperienceCall Center ExperienceMedical Terminology FamiliarityComputer LiteracyEffective Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Eligibility VerificationBenefits VerificationNon-Medical ResearchDocumentation MaintenanceTelephonic Communication

Soft Skills

Organizational SkillsTeam ParticipationConfidentiality Adherence

Tools & Technologies

Microsoft ExcelMicrosoft Word

Certifications & Qualifications

High School DiplomaGED

Industry Keywords

Pre-CertificationMedicareCommercial InsuranceRisk ManagementAccreditation

About the role

Key responsibilities & impact

Accept inbound calls from facilities, providers, and members regarding pre-certification within Medicare and Commercial Insurance
Perform intake of calls from members or providers regarding services via telephone, fax, and EDI
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
Protect the confidentiality of member information and adhere to company confidentiality policies
Communicate with Aetna Case Managers when processing transactions for members active in the program
Perform other duties and responsibilities as required

Requirements

What you’ll need

1+ years of Customer Service Background
1+ years of Call Center experience
Must have high speed internet and a secure working space
High School Diploma or equivalent GED
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
Computer literacy, including Excel and Microsoft Word
Ability to effectively participate in a multi-disciplinary team including internal and external participants
Monday-Friday availability, 12:00pm-8:30pm EST
Training availability Monday-Friday, 10:00am-6:30pm ET, for the first 8 weeks
Some holiday work may be required because the department is open 365 days a year

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
Remote work arrangement