Operations Representative II

Job not on LinkedIn

🔥 1 minute ago

🐊 Florida – Remote

🐊 Florida – Remote

💵 $17 - $28 / hour

⏰ Full Time

🟢 Junior

⚙️ Operations

🚫👨‍🎓 No degree required

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CVS Health

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1963

⚕️ Healthcare Insurance

🛒 Retail

🧘 Wellness

Healthcare Insurance • Retail • Wellness

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• 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

🎯 Requirements

• 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

🏖️ Benefits

• medical, dental, and vision coverage • paid time off • retirement savings options • wellness programs • other resources, based on eligibility