Representative II - Operations

Join to apply for the Representative II - Operations role at reputed company Join to apply for the Representative II - Operations role at reputed company At reputed company, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reputed company millions of Americans through our local reputed company, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, reputed company and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it reputed company with heart, each and every day. Position Summary As a Rep II, Operations, you will be directly supporting Medicare Part D members and providers with requests reputed company 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 reputed company you reputed company are correct and timely. This is a great opportunity to initiate a career with a leading reputed company company by reviewing information and completing timely and accurate documentation of reputed company Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience. Primary Duties And Responsibilities

• 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
• Complying with CMS mandated timelines and department productivity and quality standards
• Acquiring and maintaining basic knowledge of relevant and changing work instructions and Medicare Part D guidance
• Participate in development discussions receiving feedback from direct supervisor

Required Qualifications

• Ability to utilize multiple software systems, simultaneously with a 2-screen workstation setup (reputed company based operations, AS400, MHK, PeopleSafe, WI database, reputed company office applications)
• Ability to type 30 WPM or greater
• Excellent oral and written communication skills
• Ability to multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment
• Must be reputed company to read large volume of information and determine importance
• reputed company 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

Essential Job Functions

• Regular and predictable attendance
• Colleague will be required to work mandatory overtime/extended work week reputed company needed

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

• Must be reputed company to sit in reputed company 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 reputed company to reputed company a quiet, uninterrupted work environment. Must have a workstation that is not accessible to common traffic and is secure from unintentional reputed company.
• Must have reputed company personal high-speed internet and ability to hard-reputed company into company computer (cannot use wireless internet)

Education H.S or Equivalent required. Associate’s Degree, Bachelor’s Degree, or Other Certificates or Licenses (List): CPhT preferred. Prior Work Experience 6 mos - 3 years required. Additional years of work experience preferred. Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $17.00 - $25.65 This pay reputed company represents the reputed company hourly reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company 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 our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In reputed company to our competitive wages, our great benefits include:

• Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
• No-cost programs for reputed company 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 reputed company and many other benefits depending on eligibility.

For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will reputed company on: 08/27/2025 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Seniority level

• Seniority level

Entry level Employment type

• Employment type

Full-time Job function

• Job function

Management and Manufacturing

• Industries

Hospitals and Health Care Referrals increase your chances of interviewing at reputed company by 2x Sign in to set job alerts for “Operations Representative” roles. reputed company Provider Customer Service Representative Supervising Attorney - Bankruptcy Operations We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr Salary: USD 36000 - 60000 per year Apply To This Job