Job Title: Intake Agent/Intake coordinator
Location: 100% Remote (EST or CST candidates preferred)
Work Hours: Monday – Friday, 8:00 AM – 5:00 PM (EST hours)
Position Summary:Seeking an experienced Intake Agent with a healthcare call center background to support the Long-Term Services and Supports (LTSS) team. This is a fully remote opportunity for candidates located in EST or CST time zones who are passionate about providing exceptional member and provider service while coordinating care activities efficiently.
Key Responsibilities:Handle inbound calls from members and providers related to healthcare services via phone, fax, or EDI.
Utilize internal systems (Profax, Dynamo, QNXT) to create LTSS cases and manage member data.
Screen calls and cases for appropriate routing to clinical medical services staff.
Assist in the coordination of medical and LTSS services, including outreach and support to care teams.
Approve services that do not require clinical review based on plan guidelines.
Conduct non-clinical research including eligibility checks, coordination of benefits (COB), and benefit verifications.
Maintain accurate documentation in compliance with regulatory, accreditation, and risk management standards.
Place outbound calls to providers for additional case details or service authorizations.
Maintain strict confidentiality of member data per HIPAA and company policy.
Communicate and collaborate with internal Aetna case managers and care teams.
Support the administration of the precertification process, ensuring compliance with URAQ, NCQA, and other applicable standards.
Required Qualifications:High School Diploma or GED (Mandatory)
1–3 years of call center experience, preferably within healthcare
Strong communication and interpersonal skills (verbal & written)
Proficiency with Microsoft Word, Excel, and navigating multiple systems
Strong organizational skills and attention to detail
Ability to work independently and meet deadlines in a remote setup
Preferred Qualifications:Prior experience with Aetna or CVS Health systems
Familiarity with healthcare terminology, insurance processes, and care management
Work Environment:Fully remote (work from home)
Standard office equipment and quiet workspace required
Sedentary work involving long periods of sitting, typing, and screen time