CVS Inbound Outbound Queue Associate Customer Care

Description

CVS Health is hiring an Inbound/Outbound Queue Associate to support the coordination of medical services. This remote role involves working with members, healthcare providers, nurses, medical directors, and other teams to process requests and keep medical service workflows moving.

The position combines healthcare customer service, administrative work, data entry, and medical service coordination. You may handle incoming calls from members or providers, make outbound calls to providers, research member information, screen requests, and enter information into CVS Health/Aetna systems.

This job could be a good fit for someone with medical assistant, office assistant, healthcare, or similar clinical experience who is comfortable working with computer systems and communicating by phone. Call center and prior authorization experience can strengthen an application, while an associate degree is preferred.

Job at a Glance

Detailed Role Requirements & Responsibilities

Medical Service Coordination

The role supports the coordination of healthcare services, including intake, screening, referrals, and related administrative processes.

You will:

• Support comprehensive coordination of medical services
• Perform intake of requests
• Screen requests for appropriate referral
• Support referrals to medical service staff
• Help promote effective administration of healthcare services
• Approve services that do not require medical review when permitted under the applicable benefit plan

Inbound and Outbound Calls

Communication is an important part of the position.

You may:

• Receive calls from members or healthcare providers
• Make outbound calls to providers
• Provide information about medical authorizations
• Obtain clinical information needed for authorization decisions
• Communicate with Aetna case managers
• Communicate with nurses and medical directors when processing member transactions

Candidates should be comfortable speaking professionally with healthcare providers and other medical professionals.

Data Entry and Member Information

The role also involves detailed administrative and computer-based work.

Responsibilities include:

• Building member records in Aetna systems
• Researching member information
• Entering information accurately
• Processing transactions
• Maintaining accurate records
• Working with information received through telephone, fax, and EDI

Attention to detail is important because the work involves healthcare information and authorization-related processes.

Medical Authorization Support

The associate supports the administration of the precertification process and related medical authorization activities.

The work may involve:

• Processing authorization-related requests
• Contacting providers for clinical information
• Supporting approval of medical services
• Following applicable company procedures
• Working within relevant healthcare regulations and quality standards

Experience with prior authorization is preferred for this position.

Healthcare Systems

The job involves working with several Aetna systems, including:

• MedCompass
• QNXT
• ProFAX
• ProPAT

Experience with these specific systems can be helpful, although the available job information does not indicate that prior experience with each system is mandatory.

Team Collaboration

The associate works with people across the healthcare organization.

You may communicate with:

• Healthcare providers
• Aetna case managers
• Nurses
• Medical directors
• Medical service staff
• Other internal teams

Being able to communicate clearly and work as part of a multidisciplinary team is important.

Remote Work

The position is listed as remote and full-time, with 40 hours per week. The current listing identifies the work location as Work At Home, Louisiana.

The work is primarily computer- and phone-based, involving extended periods of sitting, talking, listening, and keyboard use.

Required Skills and Experience

The main requirements include:

• 1–2 years of experience working in the medical field
• Experience as a medical assistant, office assistant, or in another clinical/equivalent role
• High school diploma, GED, or equivalent experience
• Ability to work full-time, 40 hours per week
• Ability to work with healthcare-related information and computer systems

The employer also values problem-solving and decision-making skills.

Skills That Can Strengthen Your Application

These qualifications can make an application stronger:

• Call center experience
• Prior authorization experience
• Medical assistant experience
• Office assistant experience
• Healthcare customer service
• Medical terminology
• Data entry
• Experience with healthcare computer systems
• Telephone communication
• Customer service
• Problem-solving
• Decision-making
• Medical records or documentation
• Experience working with healthcare providers
• Associate degree
• Experience with MedCompass
• Experience with QNXT
• Experience with ProFAX
• Experience with ProPAT

Do not treat these additional skills as mandatory if you do not have them. The core qualification is relevant medical or clinical experience.

Industry Context & Career Advice

Healthcare service coordination roles sit between clinical teams, patients, providers, and administrative systems. That means employers often look for people who can communicate well while also handling detailed information accurately.

This role is a good example. It combines healthcare knowledge with customer service, data entry, phone communication, and technology. Experience with prior authorization can be especially useful because authorization work requires employees to understand requests, gather information, and follow established processes.

If you want to build a career in healthcare administration, consider developing skills in medical terminology, insurance processes, prior authorization, utilization management, healthcare information systems, and medical documentation.

For your resume, emphasize what type of healthcare work you performed, rather than simply writing “worked in healthcare.” If you regularly communicated with providers, entered patient information, handled authorizations, or used medical software, make those details visible.

What to Highlight on Your Resume

For this position, consider highlighting:

• Medical assistant experience
• Healthcare or clinical experience
• Office assistant experience
• Call center experience
• Healthcare customer service
• Prior authorization
• Medical service coordination
• Patient or member support
• Data entry
• Medical terminology
• Provider communication
• Telephone support
• Referral processing
• Medical documentation
• Healthcare computer systems
• Problem-solving
• Decision-making
• Multidisciplinary teamwork
• MedCompass
• QNXT
• ProFAX
• ProPAT

Where possible, include measurable details such as the number of calls handled, requests processed, records entered, or authorizations supported.

A stronger resume bullet for this position could be:

Coordinated healthcare service requests by communicating with providers, researching member information, entering data into medical systems, and routing requests for appropriate clinical review.

Only use this example if it accurately reflects your previous experience.

Interview Preparation

How would you handle a call from a healthcare provider requesting information?

Explain how you would verify the relevant information, listen carefully, document the request, use the appropriate system, and provide or obtain the information according to company procedures.

How do you maintain accuracy when entering member information?

Discuss how you verify information, review your entries, avoid assumptions, and follow established procedures before completing a transaction.

What experience do you have with prior authorization?

If you have worked with authorizations, explain the types of requests you handled, how you communicated with providers, and what systems you used.

How would you handle a request that needs clinical review?

Explain that you would identify the nature of the request, follow the appropriate screening process, and route it to the appropriate medical professional rather than making decisions outside your role.

How do you deal with difficult phone conversations?

Focus on listening, remaining professional, asking clear questions, showing empathy, and working toward an appropriate solution.

How comfortable are you working with multiple computer systems?

Give examples of situations where you used several systems at the same time to research information, document interactions, or complete healthcare-related tasks.

How do you prioritize work when there are many requests?

Explain how you consider urgency, deadlines, patient or member impact, and established procedures while keeping your work accurate.

Tell us about a time you worked with different healthcare professionals.

Use an example that demonstrates communication with providers, nurses, doctors, administrative staff, or another multidisciplinary team.

Advice for Applicants

This position is best suited to candidates who already have some healthcare or clinical experience. If your background includes medical assisting, healthcare office work, or another relevant medical role, make that experience the first thing recruiters see.

Call center and prior authorization experience can make your application stronger, but they are listed as preferred qualifications rather than the main experience requirement. An associate degree is also preferred.

If you are coming from a medical assistant or healthcare office background, emphasize your transferable skills: provider communication, patient or member information, data entry, medical terminology, computer systems, documentation, and problem-solving.

The remote nature of the job may be attractive to candidates who want to move from a traditional medical office or call center into a work-from-home healthcare role. However, the current listing is specifically tied to Louisiana, so applicants should confirm that they meet the location requirement before applying.

The strongest application will show that you can communicate professionally with providers, process healthcare information accurately, work confidently with computer systems, and support medical service coordination without losing attention to detail.

Benefits

This full-time position is eligible for a CVS Health benefits package that includes:

• Medical coverage
• Dental coverage
• Vision coverage
• Paid time off
• Retirement savings options
• Wellness programs
• Other resources based on eligibility