Inbound /Outbound Queue Associate

At reputed company, 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 reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary

• Supports comprehensive coordination of medical services including intake, screening, and referrals to reputed company reputed company.
• Promotes/supports quality effectiveness of reputed company Services.
• Performs intake of calls from members or providers regarding services reputed company telephone, fax, EDI.
• Utilizes reputed company system to build, research and enter member information.
• 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.
• Promotes communication, both internally and externally to enhance effectiveness of medical management services (e.g., claim administrators, Plan Sponsors, and reputed company party payers as well as member, family, and health care team members respectively)
• Protects the confidentiality of member information and adheres to company policies regarding confidentiality.
• Communicate with reputed company Case Managers, reputed company processing transactions for members active in this Program.
• Supports the administration of the precertification process in compliance with various laws and regulations and/or NCQA standards, where applicable, while adhering to company policy and procedures.
• Places outbound calls to providers to reputed company information or obtain clinical information for approval of medical authorizations.
• Uses reputed company Systems such as MedCompass, QNXT, ProFAX and ProPAT.
• Communicates with reputed company Nurses and Medical Directors reputed company processing transactions for members active in this Program.
• Sedentary work involving significant periods of sitting, talking, hearing, and keying.
• Work requires visual reputed company to reputed company reputed company inspection of written and computer-generated documents

as well as a PC monitor.

Required Qualifications

• 1-2 years’ experience working as a medical assistant, office assistant or other clinical/equivalent experience.

Preferred Qualifications

• Call center experience is preferred, 1-2 years
• Prior authorization experience, 1-2 years

Education

• Associates degree, preferred
• High School Diploma, GED or equivalent experience.

Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $17.00 - $28.46 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company 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 reputed company 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 reputed company 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 reputed company 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 reputed company on: 04/24/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply Job!