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Position SummaryAs a Rep 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.

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 (Windows based operations, AS400, MHK, PeopleSafe, WI database, Microsoft 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 able to read large volume 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.

Regular and predictable attendance

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

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.

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)

Preferred QualificationsMedicare ExperienceEducation

H.S or Equivalent

Pay Range

The typical pay range for this role is:

$17.00 - $28.45

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. In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. The Company offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company’s 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long term disability benefits. CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time and other time off are provided consistent with relevant state law and Company policies. For more detailed information on available benefits, please visit jobs.CVSHealth.com/benefits

We anticipate the application window for this opening will close on: 07/31/2024

We are an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.