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Claro Sales Advisor
BH Partner S.A.C.
Advise Claro customers about promotions and upgrades for mobile and home services. Identify customer needs and recommend suitable options while following quality standards.
Open
CVS Health is an American healthcare company working across healthcare services, health insurance, pharmacy benefits management, and retail pharmacy. Through businesses including Aetna and CVS Caremark, it supports health coverage, prescription access, condition management, specialty medications, and mail-order pharmacy services. Its neighborhood pharmacies and broader care offerings are designed to help people access essential healthcare more conveniently and affordably. CVS Health brings together insurance, pharmacy, and health services to support individuals and communities throughout their care journeys.
Remote Inbound and Outbound Queue Associate at CVS Health
CVS Health is hiring a remote queue associate to coordinate Aetna member and provider service requests. The role covers intake, eligibility checks, referrals, benefits verification, and precertification support.
Description
- Coordinate medical service requests through intake, screening, and referral activities
- Support healthcare service quality and effectiveness initiatives
- Handle member and provider service inquiries through telephone, fax, and EDI
- Build, research, and update member records in Aetna systems
- Review requests and route those requiring medical services staff involvement
- Approve benefit-plan services that do not require medical review
- Conduct non-medical research, including eligibility, coordination of benefits, and benefit verification
- Maintain complete and accurate records in line with risk management, regulatory, and accreditation standards
- Facilitate communication among claim administrators, plan sponsors, third-party payers, members, families, and healthcare teams
- Safeguard member information in accordance with company confidentiality policies
- Coordinate applicable member transactions with Aetna Case Managers, Nurses, and Medical Directors
- Support precertification administration in accordance with applicable laws, regulations, and NCQA standards
- Contact providers outbound to share information or obtain clinical details for medical authorization approvals
- Work with Aetna systems including MedCompass, QNXT, ProFAX, and ProPAT
- Perform sedentary duties requiring extended periods of sitting, speaking, listening, and keyboard use
- Review written materials, computer-generated documents, and information displayed on a PC monitor
Requirements
- One to two years of experience as a medical assistant, office assistant, or in comparable clinical or equivalent work
- High school diploma, GED, or equivalent experience
- Ability to establish a direct, hardwired internet connection from the modem or router to the computer within 7 feet
- Internet service with at least 25 Mbps download and 3 Mbps upload speeds
- WiFi and satellite internet connections are not permitted
- A quiet, secure, private home workspace that meets CVS Health and HIPAA requirements
- Ability to work from the state and city where currently residing
- Ability to provide workspace furniture, such as a desk or standing desk
- Comfort using multiple monitors and navigating several applications at once
- Ability to communicate through email, calendar invitations, Teams messages, and virtual meetings
- Experience with Microsoft Office 365, including Teams, Outlook, Word, Excel, and PowerPoint, or comparable Google Workspace tools
- Ability to access secure systems such as VPNs and EHR portals
- Understanding of computer security practices, including screen locking, strong password management, and identifying suspicious emails or links
- Ability to troubleshoot common technical problems independently
- Willingness to develop new skills as workplace needs change
- Associate degree preferred
- One to two years of call center experience preferred
- One to two years of prior authorization experience preferred
Benefits
- Eligibility for a CVS Health bonus, commission, or short-term incentive program in addition to base pay
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Additional resources subject to eligibility
- Company-provided equipment, including a keyboard, monitor, computer, and headset
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