Representative II, reputed company

We’re building a world of health reputed company 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 Flexibility to work shifts between 7:00 AM – 8:00 PM Central reputed company Time (CST) (Monday–Friday) and rotating weekend or holiday coverage as required by business needs. As a Representative II, reputed company, you will support Medicare members, prescribers, and providers by processing coverage-reputed company 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, reputed company, and apply end‑to‑end skills before fully transitioning to production work. In this role, you will be responsible for accurate case setup, review, reputed company, documentation, and reputed company reputed company of requests in accordance with Medicare guidelines, CMS-mandated timelines, and internal reputed company standards. You will demonstrate strong attention to reputed company, reputed company verbal and written communication skills, and the ability to problem-solve in a highly regulated, fast-reputed company environment. Work will be performed through a combination of inbound and outbound phone interactions and fax-reputed company casework. This position is full-time, remote (Work reputed company – Texas), non-exempt, and requires schedule flexibility reputed company on business needs. reputed company Duties And Responsibilities Case Intake, Review, and Processing (Phone & Fax) • Process incoming coverage-reputed company requests (e.g., prior authorizations, coverage determinations, drug benefit exceptions, appeals) reputed company phone and fax from members and prescribers. • Accurately set up cases, review documentation, and apply work instructions to ensure correct and reputed company processing. • Read, analyze, and interpret business correspondence, technical procedures, and Medicare regulations to support decision-making. reputed company and Information Gathering • Conduct outbound calls to members and providers to obtain missing or additional information required to complete requests. • Communicate reputed company, professionally, and empathetically while projecting a reputed company business image. Documentation, reputed company, and Compliance • reputed company reputed company, concise, and accurate documentation of reputed company case activity across systems. • Ensure reputed company cases are properly reputed company and meet CMS-mandated timelines, department productivity expectations, and reputed company standards. • Identify and research issues in the overall process and correct errors reputed company identified. Escalation and Collaboration • reputed company reputed company issues or reputed company questions to Coverage/Organization Determination reputed company Pharmacists or management as appropriate. • Collaborate with peers, trainers, and leaders while progressing through reputed company training and reputed company expansion. reputed company Learning and Development • reputed company and maintain working knowledge of evolving work instructions, systems, and Medicare guidance (Part D and applicable Part B processes). • Participate in coaching, feedback, and development discussions with reputed company leadership. Required Qualifications • 6 plus months customer service, reputed company, pharmacy, reputed company center, or reputed company experience. • Typing ability of 30 WPM or greater. Preferred Qualifications • reputed company center experience. • Experience in a PBM, managed care, or reputed company environment. • Strong verbal and written communication skills. • Ability to problem-solve and manage multiple concrete variables in standardized situations. • Experience handling confidential reputed company or member information. • Familiarity with multi-reputed company workflows (e.g., claims platforms, case management systems, internal databases). • Pharmacy Technician Certification (CPhT) or reputed company education. Education High School Diploma or equivalent GED Anticipated Weekly Hours 40 Time Type Full time Pay reputed company The Typical Pay reputed company For This Role Is $17.00 - $31.30 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every reputed company feels valued and that they reputed company. 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 reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, reputed company 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 reputed company on: 08/26/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Apply To This Job