[Hiring] Inbound/Outbound Queue Associate @CVS Health

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Role Description

This role involves supporting comprehensive coordination of medical services including intake, screening, and referrals to Aetna Better Health.

  • Promotes/supports quality effectiveness of Healthcare Services.
  • Performs intake of calls from members or providers regarding services via telephone, fax, EDI.
  • Utilizes Aetna system to build, research and enter member information.
  • Screens requests for appropriate referral from medical services staff.
  • Approves 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 third-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.
  • Communicates with Aetna Case Managers when 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 provide information or obtain clinical information for approval of medical authorizations.
  • Uses Aetna Systems such as MedCompass, QNXT, ProFAX and ProPAT.
  • Communicates with Aetna Nurses and Medical Directors when processing transactions for members active in this Program.
  • Sedentary work involves significant periods of sitting, talking, hearing, and keying.
  • Work requires visual acuity to perform close inspection of written and computer-generated documents as well as a PC monitor.

Qualifications

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

Requirements

  • Call center experience is preferred, 1-2 years.
  • Prior authorization experience, 1-2 years.
  • Prefer Eastern or Central Time Zone Candidates.

Education

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

Benefits

  • Affordable medical plan options.
  • 401(k) plan (including matching company contributions).
  • 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.
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About United Kingdom

The United Kingdom is an island nation located on the northwest coast of Europe. The United Kingdom includes the entire island of Great Britain, which includes England, Wales, and Scotland, as well as the northern part of the island of Ireland. The name Great Britain is sometimes used to refer to the United Kingdom as a whole. The capital is London, which is one of the business, financial, and cultural centers of the world. Other major cities are Birmingham, Liverpool, and Manchester in England, Belfast and Londonderry in Northern Ireland, Edinburgh and Glasgow in Scotland, and Swansea and Cardiff in Wales.

Common Interview Questions

  • Tell me about yourself.
  • Walk me through your resume.
  • How did you hear about this position?
  • Why do you want to work at this company?
  • Why do you want this job?
  • Why should we hire you?
  • What can you bring to the company?
  • What are your greatest strengths?
  • What do you consider to be your weaknesses?
  • What is your greatest professional achievement?
  • Tell me about a challenge or conflict you’ve faced at work, and how you dealt with it.
  • Tell me about a time you demonstrated leadership skills.
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  • Tell me about a time you made a mistake.
  • Tell me about a time you failed.
  • Why are you leaving your current job?
  • Why were you fired?
  • Why was there a gap in your employment?
  • Can you explain why you changed career paths?
  • What’s your current salary?
  • What do you like least about your job?
  • What are you looking for in a new position?
  • What type of work environment do you prefer?
  • What’s your work style?
  • What’s your management style?
  • How would your boss and coworkers describe you?
  • How do you deal with pressure or stressful situations?
  • What do you like to do outside of work?
  • Are you planning on having children?
  • How do you stay organized?
  • How do you prioritize your work?
  • What are you passionate about?
  • What motivates you?
  • What are your pet peeves?
  • How do you like to be managed?
  • Do you consider yourself successful?
  • Where do you see yourself in five years?
  • How do you plan to achieve your career goals?
  • What are your career aspirations?
  • What’s your dream job?
  • What other companies are you interviewing with?
  • What makes you unique?
  • What should I know that’s not on your resume?
  • What would your first few months look like in this role?
  • What are your salary expectations?
  • What do you think we could do better or differently?
  • When can you start?
  • Are you willing to relocate?
  • How many tennis balls can you fit into a limousine?
  • If you were an animal, which one would you want to be?
  • Sell me this pen.
  • Is there anything else you’d like us to know?
  • Do you have any questions for us?

Educational Qualification

Candidates Who Have Passed Graduate or its Equivalent from a Recognized Board or University Are Eligible For this recruitment. Kindly check the Official Notification for more qualification details. Notification Link Is Given Below.

Document Required

Required Documents for This recruitment: Candidate should have these documents before applying online. Candidates are suggested to read the official notification before applying.

  • Qualification certificate with mark sheets.
  • Passport size photographs.
  • Signature.

How to Apply

All the eligible candidates can apply for this job as mentioned below:

  • Read official notification carefully from the official website.
  • Read notification carefully before applying.
  • Fill the application form (link is given below).
  • Attach required documents and passport size photo with signature.
  • Then submit. Done.