Inbound/Outbound Queue Associate

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.

As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

• Job Description

Primary Job Duties & Responsibilities
Follows management-established procedures to execute routine business support tasks for core Inbound and Outbound communications functions, under general supervision.
Develops effective relationships with all team members to effectively progress daily communications to resolve issues and prevent delays in service or responses.
Handles Inbound and Outbound tasks in a manner that operates in full compliance with patient confidentiality policies and regulations.
Maintains accurate and complete documentation of member health information to minimize risk management, while adhering to all regulatory, and accreditation requirements.
Reviews requests for appropriate referral to medical services staff and approves services that do not require a medical review.
Escalates more complex customer/member inbound inquiries to management for more thorough follow-up and resolution.
Takes management direction to properly execute techniques, processes, and responsibilities according to established work area policies and procedures.
Documents all Inbound and Outbound phone details into the company database to ensure full collection of customer/patient needs and requirements.
Demonstrates active listening skills while handling customer/patient calls, also exerting compassion and understanding to gain customer/patient trust and loyalty.


Education
High school diploma or up to 1 year equivalent experience.

Prior Relevant Work Experience
0-1 year

Essential Qualifications
Working knowledge of problem solving and decision making skills

*Shift Available: Tuesday-Saturday 1:00pm-9:30pm EST

*Training: 10:00 AM - 6:30 PM ET, for first 8 weeks
*Some Holidays required.

Position Summary

Inbound Queue Associate - Behavioral Health role is responsible for accepting inbound calls from facilities, providers, and members regarding pre-certification process within Medicare and Commercial Insurance.

Responsibilities to include but limited to the following:

• • Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
  • Screens requests for appropriate referral to medical services staff.
  • Approve services that do not require a medical review in accordance with the benefit plan.
  • Performs non-medical research including eligibility verification, COB, and benefits verification.
  • Maintains accurate and complete documentation of required information that meets risk management, regulatory, and accreditation requirements.
  • Protects the confidentiality of member information and adheres to company policies regarding confidentiality
  • Communicate with Aetna Case Managers, when processing transactions for members active in this program
  • Other duties and responsibilities as required.

Required Qualifications

• • 2 plus years of Customer Service Background
  • 2 plus years of Call Center experience

Preferred Qualifications

• • 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 to coordinate service delivery including attention to customers, sensitivity to issues, proactive identification and resolution of issues to promote positive outcomes for members.
  • Computer literacy in order to navigate through internal/external computer systems, including Excel and Microsoft Word.
  • Ability to effectively participate in a multi-disciplinary team including internal and external participants

Education

High School Diploma or equivalent GED

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$17.00 - $25.65

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.

• No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.

• Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits

We anticipate the application window for this opening will close on: 03/19/2025

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.