Representative I

Position Summary

The Coverage Determination/Appeals Service Representative I is responsible for working and triaging in the data entry related fax queues. The Representative I’s primary responsibilities will be to review each document with accuracy and place the case in the proper queues. Further responsibilities include researching reports, maintaining complete, timely and accurate documentation of Coverage Determination/Appeal requests and escalating issues to the Coverage Determination/Appeal pharmacists or management staff as needed.

Primary Duties And Responsibilities

• Review Fax documents appropriately and forward to appropriate queues
• Update and maintain knowledge of relevant process, regulation and clinical material
• Provide assistance or guidance in partnership with learning and innovation when needed
• Participate in developmental discussions receiving feedback with Supervisor

Essential Job Functions

• Regular and predictable attendance
• Colleague will be required to work mandatory overtime/extended work week when needed

Physical Requirements

• Sit, stand, stoop, bend and walk
• Must be able to work in front of computer for duration of shift
• Type on a keyboard or utilize a computer mouse for an extended period

Work Environment

• Climate-controlled, smoke-free internal environment
• Work to be performed regularly in a CVS Health location, with the option to work-from-home at the discretion of the colleague’s leader
• Work At Home Dedicated home workspace needed
• Must be able to provide a quiet, uninterrupted work environment
• Must have a workstation that is not accessible to common traffic and is secure from unintentional access
• Must have stable personal high-speed internet and ability to hard-wire into company computer (cannot use wireless internet)

Hybrid Work from Site Location

• Colleague will work from office location and work virtual from home
• Requirement for hybrid to report to office 3 days a week

Required Qualifications

• 6 mos - 3 years required
• Additional years of work experience preferred
• Proficient computer skills and the ability to navigate in a Window’s based environment
• Ability to follow directions and adapt in a dynamic work environment
• Demonstrated sense of urgency with assignments
• Ability to read, analyze and interpret general business correspondence, technical procedures, and governmental regulations
• Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations
• Ability to perform basic mathematic calculations maybe required
• Ability to interpret a variety of work instructions provided through a variety of mediums

Preferred Qualifications

• Excellent verbal and written communication and interpersonal skills with ability to maintain patient confidentiality
• Demonstrated problem-solving ability and attention to detail
• Strong organizational skills

Education

• H.S or Equivalent required
• Associate’s Degree or Bachelor’s Degree, preferred

Anticipated Weekly Hours

• 40

Time Type

• Full time

Pay Range

• The Typical Pay Range For This Role Is $17.00 - $28.46

Additional Details

• This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above
• 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