Representative II Operations – Medicare D Quality

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

– Learning the rework queues for each line of business

– Working rework reports timely

– Researching and troubleshooting failed claims

– Adding and/or editing overrides in RxClaim

– Logging audits and errors accurately and timely

– Ability to identify trends and provide suggestions for process improvement

– 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.

– Ensuring all cases are properly closed.

– Ability to interpret a variety of work instructions provided through multiple mediums.

– Ability to anticipate needs and resolve issues with urgency and to meet quality and production standards.

Required Qualifications

– 2 plus years of Coverage Determination & Appeals experience.

– MHK, RxClaim, and People Safe proficient.

– Meeting quality and productivity metrics in current role.

Preferred Qualifications

– 3 plus year of Coverage Determination & Appeals experience.

– 1 plus year of Medicare PART B experience

– MHK, RxClaim, and People Safe proficient.

– Meeting quality and productivity metrics in current role.

Education

High School Diploma or equivalent GED

Pay Range

The typical pay range for this role is:

$17.00 – $31.30

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 Benefits | CVS Health (https://jobs.cvshealth.com/us/en/benefits)

We anticipate the application window for this opening will close on: 10/18/2024

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

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.