Representative II - Operations

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.

Position Summary

As a Representative II, Operations, you will be directly supporting Medicare Part D members and providers with requests related to their pharmacy benefits. You will be responsible for accurately setting up cases for members, review criteria for approving requests, reaching out to providers for more information to decision requests and ensuring decisions you make are correct and timely. This is a great opportunity to initiate a career with a leading healthcare company by reviewing information and completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.

Primary Duties and Responsibilities

1. Ensure accurate case setup and review of Medicare appeals cases

• Reviewing internal notes or fax requests thoroughly for pertinent information
• Providing clear, concise, and accurate documentation for case reviews
• Contacting providers to obtain additional information
• Utilize work instructions for accurate case processing

2. Complying with CMS mandated timelines and department productivity and quality standards

3. Acquiring and maintaining basic knowledge of relevant and changing work instructions and Medicare Part D guidance

4. Participate in development discussions receiving feedback from direct supervisor

Essential Job Functions

1. Regular and predictable attendance

2. Colleague will be required to work mandatory overtime/extended work week when needed

Physical Requirements [ex. Sit, stand, stoop, bend and walk]

• Must be able to sit in front of computer for duration of shift
• Required to type on a keyboard or utilize a mouse throughout shift

Work Environment

Work from Home position

• Dedicated home workspace needed. Must be able to provide a quiet, uninterrupted work environment. Must have a workstation that is not accessible to common traffic and is secure from unintentional access.
• Must have stable personal high-speed internet and ability to hard-wire into company computer (cannot use wireless internet)

Required Qualifications

• Ability to utilize multiple software systems, simultaneously with a 2-screen workstation setup (Windows based operations, AS400, MHK, PeopleSafe, WI database, Microsoft office applications)
• Ability to type 30 WPM or greater
• Must be able to read large volumes of information and determine importance
• Receptive to constructive feedback and flexible in adapting to change
• Flexibility with working a rotating schedule including overtime, weekends, and holidays Previous 6 months experience in Managed Care/PBM environment

Preferred Qualifications

• Excellent oral and written communication skills
• Ability to multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment

Education

High School Diploma or equivalent GED

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

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.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.