Inbound/Outbound Queue Associate - Behavioral Health

CVS Health

2d • 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. Position Summary Shift Available: Monday- Friday; 11:00am-07:30pm EST Training: Monday-Friday; 10:00am-6:30pm EST for 9 weeks Holidays required. This is a fully remote position and the following are some required Work from Home criteria which includes but is not limited to maintaining your own internet with approved speed requirements, secure workspace free from distractions, and successful completion of the training program. Download speed 25mbps or more and upload speed 10 mbps or more. Hard wiring into modem will be required. 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

Requirements

• 1-3 years of Customer Service Background
• 1-3 years of Call Center experience.
• Download speed 25mbps or more and upload speed 10 mbps or more. Hard wiring into modem will be required.
• maintaining your own internet with approved speed requirements, secure workspace free from distractions, and successful completion of the training program.
• 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

Benefits

• This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families.
• The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.
• Additional details about available benefits are provided during the application process and on Benefits Moments.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees