Representative II, Pharmacy Operations

JobDiva, Inc.; Woonsocket (RI); On-site; USD 28,000 - 32,000; Full time

Job summary

NTT DATA Services seeks a Rep II, Operations to support Medicare members, prescribers, and providers by processing coverage-related requests across phone and offline channels. The role emphasizes accurate case setup, timely resolution, and adherence to CMS timelines.

The position is remote, full-time, non-exempt, with flexible shifts between 7:00am–8:00pm CST and potential overtime during peak periods. Contract-to-hire arrangement offered.

Qualifications

• Minimum of 6+ months customer service, healthcare, pharmacy, call center, or related experience.
• Experience in a PBM, managed care, or healthcare environment preferred.
• Experience handling confidential patient or member information.

Responsibilities

• Assist Medicare members, prescribers, and providers by processing coverage-related requests via phone and fax.
• Ensure accurate case setup, review, outreach, documentation, and timely resolution per CMS timelines and quality standards.
• Work in a remote, full-time capacity with flexible shifts and potential overtime during peak periods.

Skills

Customer service

Healthcare

Pharmacy

Education

Pharmacy Technician Certification (CPhT)

Job description

At NTT DATA, we know that with the right people on board, anything is possible. The quality, integrity, and commitment of our employees have been key factors in our company’s growth and market presence. By hiring the best people and helping them grow both professionally and personally, we ensure a bright future for NTT DATA and for the people who work here.

For more than 25 years,NTT DATA Serviceshave focused on impacting the core of your business operations with industry-leading outsourcing services and automation. With our industry-specific platforms, we deliver continuous value addition, and innovation that will improve your business outcomes. Outsourcing is not just a method of gaining a one-time cost advantage, but an effective strategy for gaining and maintaining competitive advantages when executed as part of an overall sourcing strategy.

To ensure proper evaluation, candidates must submit a current and accurate resume reflecting their actual employment history, relevant experience, and qualifications. Applications containing insufficient, incomplete, or unverifiable information may be excluded from consideration.

Representative II-Medicare

Location: Remote

Pay Rate: $20.25 per hour

Start Date: 11/2/2026 approx.

Shift: M-F Flexible (see below)

Flexibility to work shifts between 7:00am – 8:00pm CST (Monday–Friday) and rotating weekend or holiday coverage as required by business needs.

Employment Type: Contract to Hire /Not a Direct Hire

Position Summary:

As a Rep II, Operations, you will support Medicare members, prescribers, and providers by processing coverage-related requests across both phone and fax (offline) channels. This role integrates responsibilities previously segmented by channel (phone vs. fax) and line of business (Medicare Part D and applicable Medicare Part B processes), reflecting the organization’s modularized training model in which colleagues progressively learn, practice, and apply end‑to‑end skills before fully transitioning to production work.

In this role, you will be responsible for accurate case setup, review, outreach, documentation, and timely resolution of requests in accordance with Medicare guidelines, CMS-mandated timelines, and internal quality standards. You will demonstrate strong attention to detail, professional verbal and written communication skills, and the ability to problem-solve in a highly regulated, fast-paced environment. Work will be performed through a combination of inbound and outbound phone interactions and fax-based casework.

This position is full-time, remote (Work at Home), non-exempt, and requires schedule flexibility based on business needs.

Schedule and Work Environment

• Schedule:
  • Flexibility to work shifts between 7:00am – 8:00pm CST (Monday–Friday) and rotating weekend or holiday coverage as required by business needs.
  • Overtime and extended hours may be required during peak periods.
• Work Environment:
  • Remote, work‑from‑home position.
  • Dedicated, secure, and quiet home workspace required.
  • Reliable high-speed internet with ability to hard‑wire into company equipment (NOwireless connection, NOhotspots).

Essential Functions and Physical Requirements:

• Regular and predictable attendance.
• Ability to work mandatory overtime or extended workweeks when required.
• Ability to sit for extended periods at a computer workstation.
• Ability to type and use a mouse throughout the duration of the shift.

Role Context (Training Model Alignment):

This role reflects an integrated Rep II model aligned with modularized training. Colleagues are trained across both phone and fax‑based workflows and progressively apply learned skills through practice before full production deployment. Channel assignment (phone vs. offline work) and case mix may vary based on business needs, proficiency, and operational demand.

Required Qualifications:

Minimum of 6+ months customer service, healthcare, pharmacy, call center, or related experience.

Preferred Qualifications:

• Call center experience.
• Experience in a PBM, managed care, or healthcare environment.
• Experience handling confidential patient or member information.
• Familiarity with multi‑system workflows (e.g., claims platforms, case management systems, internal databases).
• Pharmacy Technician Certification (CPhT) or related education.

Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is ($20.25 hourly ). This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on several factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications.

This position is eligible for company benefits that will depend on the nature of the role offered. Company benefits may include medical, dental, and vision insurance, flexible spending or health savings account, life, and AD&D insurance, short-and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits.

About NTT DATA Services:

NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge‑to‑cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long‑term success. Visit nttdata.com or LinkedIn to learn more.

NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.