Our company purpose is to help people on their path to better health. As an Appeals Representative, you will be directly supporting Medicare Part D members and providers with appeal requests related to their pharmacy benefits. This is a great opportunity to initiate a career with a leading healthcare company by completing timely and accurate documentation of all Medicare Part D requests, in compliance with Medicare guidelines, while promoting a best-in-class service experience.
In this role, you will be responsible for:
• Utilizing multiple software systems to complete Medicare appeals case reviews
• Meeting or exceeding government mandated timelines
• Complying with turnaround time, productivity and quality standards
• Conveying resolution to beneficiary or provider via direct communication and professional correspondence
• Acquiring and maintaining basic knowledge of relevant and changing Med D guidance
• Position includes 8 hour shifts with rotating weekends (currently every 4th).
• Accountable and results driven
• Critical thinker/problem solver
• Receptive to constructive feedback and flexible in adapting to change
• Ability to effectively plan, prioritize, and organize time and workload
• Ability to execute successfully in a deadline-oriented, fast-paced, highly-regulated environment
• Proficient in navigation of multiple computer applications
• Proficient use of keyboard, mouse and ability to navigate 2 workstation monitors
• Ability to type more than 30 WPM
• At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service
• Six months of PBM/pharmaceutical related work strongly desired
High School Diploma or GED required.
Bachelor's degree in related field or equivalent work experience preferred
It's a new day in health care.
Combining CVS Health and Aetna was a transformative moment for our company and our industry, establishing CVS Health as the nation's premier health innovation company. Through our health services, insurance plans and community pharmacists, we're pioneering a bold new approach to total health. As a CVS Health colleague, you'll be at the center of it all.
We offer a diverse work experience that empowers colleagues for career success. In addition to skill and experience, we also seek to attract and retain colleagues whose beliefs and behaviors are in alignment with our core values of collaboration, innovation, caring, integrity and accountability.
CVS Health is an equal opportunity/affirmative action employer. Gender/Ethnicity/Disability/Protected Veteran – we highly value and are committed to all forms of diversity in the workplace. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities. We comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT. We provide reasonable accommodations to qualified individuals with disabilities. If you require assistance to apply for this job, please contact our Advice and Counsel Reasonable Accommodations team. Please note that we only accept applications for employment via this site.
If technical issues are preventing you from applying to a position, contact Kenexa Helpdesk at 1-855-338-5609 or email@example.com. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352.
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