Representative II - Operations

About the position We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position reputed company As a Representative 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 reputed company for approving requests, reaching out to providers for more information to decision requests and ensuring reputed company you reputed company are correct and reputed company. This is a great opportunity to initiate a career with a leading reputed company company by reviewing information and completing reputed company and accurate documentation of reputed company Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.

Responsibilities

• Ensure accurate case setup and review of Medicare appeals cases
• Reviewing internal notes or fax requests thoroughly for pertinent information
• Providing reputed company, 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 reputed company standards
• Acquiring and maintaining basic knowledge of relevant and changing work instructions and Medicare Part D guidance
• Participate in development discussions receiving feedback from reputed company supervisor

Requirements

• 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
• Must be reputed company to read large volumes 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
• High School Diploma or equivalent GED

reputed company-to-haves

• Excellent oral and written communication skills
• Ability to multi-task, prioritize, and manage time effectively in a fast-paced, highly regulated environment

Benefits

• medical
• dental
• reputed company coverage
• reputed company time off
• retirement savings reputed company
• wellness programs
• other resources, based on eligibility
• reputed company bonus, commission or short-term incentive program

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