Inbound Outbound Que Associate

Job description

CVS Health Remote Medical Prior Authorization Role 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. This is a fully remote from home position Training Schedule: Monday through Friday 9am to 5:30pm local time (no time off during 9 week training) Post Training Work Schedule: Monday through Friday 11:30am - 8pm ET Position Summary: This role supports medical prior authorization (precertification) operations by taking inbound calls from members and providers, building cases in multiple systems, and ensuring accurate documentation and HIPAA-compliant handling of PHI/PII. Ideal candidates bring experience in a health insurance environment, familiarity with medical terminology and clinical workflows, and confidence working in a technology-driven, multi-system setting. Required Qualifications • 1+ year of customer service/call center experience (healthcare, health insurance, or medical office preferred) • Familiarity with health insurance concepts and workflows (e.g., prior authorization/precertification, utilization management, benefits, claims terminology) • Working knowledge of HIPAA privacy practices and ability to handle PHI/PII appropriately • Comfort navigating multiple computer applications at once (case tools/CRM, web portals) with accurate, fast data entry • Strong verbal communication, active listening, documentation, and de-escalation skills • Must be on camera during training Preferred Qualifications • 1+ year in a health plan, utilization management, prior authorization, or provider services environment • Clinical or medical office background (e.g., medical assistant, medical office assistant, patient access, referrals/prior auth coordinator) • Experience working with provider portals, EHR/EMR systems, or authorization/case management platforms • Understanding of common medical codes and terminology (e.g., CPT/HCPCS/ICD-10) and ability to collect the correct clinical documentation (as applicable to the role) • Familiarity with job aides/process flows including AI assisted features Education: High School diploma or equivalent 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 offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. 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.