Inbound/Outbound Queue Associate - Behavioral Health

CVS Health•Work At Home-Illinois, MA

1d•Remote

About The Position

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Requirements

1-3 years of Customer Service Background
1-3 years of Call Center experience.
High School Diploma or G.E.D., equivalent experience

Nice To Haves

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

Responsibilities

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.