Description
Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors™ support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. *Position Summary* As a Rep II, Operations, you will be directly supporting Medicare Part D & B 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 & B requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience. Hours of operation are 8:00am – 5:00pm Hawaii Time (Monday – Friday), some holidays may be required. As a Rep II, Operations, you'll show a high level of attention to detail, verbal and written communications skills, and the ability to problem solve in this dynamic work environment. You'll be working various assignments that require demonstrated urgency and the ability to meet set timelines. You'll have the opportunity to project a professional business image through phone interactions as well as internal communication. Your responsibilities will include: - Working incoming cases via phone (primarily) or fax to process coverage requests from members or prescribers - Conducting outreach to patients and providers, and obtaining additional information needed to process requests - Researching and correcting any issues found in the overall process - Raising issues to Coverage Determination Clinical Pharmacists and Management team as needed - Reading, analyzing, and interpreting general business correspondence, technical procedures, and governmental regulations - Solving practical problems and dealing with multiple concrete variables in standardized situations - Performing basic mathematical calculations - Providing clear, concise, and accurate documentation for case reviews - 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 & B guidance - Participate in development discussions receiving feedback from direct supervisor - Proficient computer skills and the ability to navigate in a Windows based environment including the ability to toggle between multiple software systems, simultaneously with a 2-screen workstation setup (Windows based operations, AS400, MHK, NLX, PeopleSafe, WI database, Microsoft office applications) *Required Qualifications* 6+ months of customer service, pharmacy or related experience Resident of Hawaii *Preferred Qualifications* Call center experience Pharmacy or PBM environment preferred highly. Experience in a role requiring maintenance of patient confidentiality. Ability to type 30 WP or greater. *Education* Verifiable High School Diploma or GED required. Preferred CPhT license *Pay Range* The typical pay range for this role is: $17.00 - $29.88This 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](https://jobs.cvshealth.com/benefits) We anticipate the application window for this opening will close on: 05/01/2024
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