Remote Medicare Operations Specialist II

CVS Health Corporation; Town of Texas (WI); Hybrid; USD 23,000 - 43,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus program

Wellness programs

Job summary

CVS Health Corporation seeks a Representative II, Operations to support Medicare members and providers, handling coverage requests via phone and fax in a remote Texas setting. You will set up cases, gather information, document activity, and ensure timely resolutions within CMS timelines.

Successful candidates have 6+ months in healthcare or call center roles, strong typing skills, and excellent communication. Training and growth opportunities accompany a comprehensive benefits package.

Qualifications

• 6+ months customer service, healthcare, pharmacy, call center, or related experience.
• Typing ability of 30 WPM or greater.
• Experience in a PBM, managed care, or healthcare environment (preferred).
• Pharmacy Technician Certification (CPhT) or related education (preferred).

Responsibilities

• Process incoming coverage-related requests via phone and fax.
• Accurately set up cases, review documentation, and apply work instructions.
• Conduct outbound calls to members and providers to obtain missing information.
• Provide clear, concise, and compliant documentation of all case activity.
• Escalate complex issues to pharmacists or management as appropriate.
• Collaborate with peers during modular training and skill expansion.
• Maintain knowledge of evolving Medicare guidance and CMS timelines.

Skills

Customer service

Typing 30 WPM

Phone support

Communication

Education

High School Diploma or GED

Job description

CVS Health Corporation seeks a Representative II, Operations to support Medicare members and providers, handling coverage requests via phone and fax in a remote Texas setting. You will set up cases, gather information, document activity, and ensure timely resolutions within CMS timelines.

Successful candidates have 6+ months in healthcare or call center roles, strong typing skills, and excellent communication. Training and growth opportunities accompany a comprehensive benefits package.