Prior Authorization Representative (Work from Home)

CVS Health Corporation; United States; Remote; USD 23,000 - 34,000; Full time

Job summary

CVS Health is seeking a Representative I to be the first point of contact for Prior Authorization requests from members, providers, and a diverse customer base. You will assess and determine if a complex request should be escalated to a pharmacist for assistance.

You will maintain complete, timely, and accurate documentation of all approvals and denials, using multiple software systems as you support a patient-centered workflow. Schedule flexibility includes nights, weekends, and holidays.

Qualifications

• 1 year of experience in customer service or call center environment.
• Must be able to work from home.
• Have high speed internet.

Responsibilities

• Be the initial point of contact for Prior Authorization requests from members, providers, and diverse customers.
• Determine if a complex request should be transferred to a pharmacist for assistance.
• Maintain complete, timely, and accurate documentation of approvals and denials.
• Navigate multiple software systems to document conversations and outcomes; work with occasional night, weekend, and holiday shifts.

Skills

Customer service

Remote work

Education

High School Diploma or GED

Job description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselvesaccountable and prioritize safety and quality 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.

Job Summary

The Representative I is the initial point of contact for Prior Authorization requests from members, providers, and a diverse customer base. The Rep I will make the determination if a complex request should be transferred to a pharmacist for assistance. Additionally, the Rep I is responsible for maintaining complete, timely, and accurate documentation of all approvals and denials.

In order to be successful in this role you will need proficiency pronouncing drug names and diagnosis and recognizing medical terminology. As well as navigating multiple software systems to document conversations and outcomes, which require keyboarding skills. This position requires schedule flexibility including rotations through nights, weekend and holiday coverage.

Required Qualifications

• 1 year experience in customer service or call center environment
• Must be able to work from home
• Have high speed internet

Preferred Qualifications

• Previous experience in pharmacy or healthcare industry.
• Associate’s or Bachelor’s Degree. Pharmacy Technician License

Education

High School Diploma or equivalent GED

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$17.00 - $25.65

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.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 10/30/2026

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