Tech I

About the role

As a Tech I Prior Auth at CVS Health, you’ll handle in-bound calls from providers, pharmacies, members, and others, providing professional and courteous phone assistance through the criteria-based prior authorization process. You’ll maintain complete, timely, and accurate documentation of reviews and transfer clinical questions, escalations, and judgment calls to the pharmacist team. Additional duties include outbound calls, reviewing and processing Prior Auths received via fax and ePA, monitoring and responding to inquiries via department mailboxes, and other tasks assigned by the leadership team.

Responsibilities

• Effectively manage work volume by handling inbound calls, fax, and ePA requests with courteous and professional behavior based on established standards (40%).
• Comply with departmental, company, state, and federal requirements to ensure accuracy of information provided to internal and external customers (40%).
• Communicate with internal groups (seniors, pharmacists, appeals, etc.) regarding determination status and results (10%).
• Identify and escalate clinical inquiries to the pharmacist team as appropriate (5%).
• Perform other duties as assigned, such as faxing, sorting, managing email boxes, CAS maintenance, etc. (5%).

Requirements

• 6 months of customer service or pharmacy technician experience.
• Regular and predictable attendance.
• Ability to work mandatory overtime or extended work weeks when needed.
• Ability to travel when required.
• High school diploma or equivalent (GED).

Skills

• Basic computer skills, including knowledge of Microsoft Office Suite (Excel and Word required; Access, Outlook, PowerPoint, and Visio preferred).
• Strong keyboard skills and ability to multitask using multiple system applications simultaneously.
• Basic pharmaceutical knowledge, including terminology, calculations, and protocols.
• Ability to utilize available resources independently and produce high-quality work.
• Strong problem-solving skills, motivation, and ability to absorb presented information.
• Adaptability to changing workflows and shifting priorities.
• Excellent written, verbal, grammar, and listening communication skills.
• Ability to interact confidently and professionally with a diverse customer base (internal and external).
• Commitment to maintaining confidentiality of Protected Health Information (PHI).

Physical Requirements

• Long periods of sitting (up to 100% of the time).
• Talking on the phone for extended periods (90-100% of the time).
• Reading a computer screen for extended periods (100% of the time).

Work Environment

This is a home office position. Your workspace must comply with CVS Health privacy and security policies and procedures. Key requirements include:

• Ensuring computer screens are not accessible or viewable by others.
• Keeping telephone conversations involving confidential information inaudible to others in the home.
• Securing CVS equipment and documents to prevent access by others during and outside business hours.
• Locking or turning off computers when not in use to secure confidential information.

Schedule

• Full-time position.
• Anticipated weekly hours: 40.

Pay

The typical pay range for this role is $17.00 - $31.30 per hour. The actual base salary offer will depend on factors such as experience, education, geography, and other relevant considerations. This position is also eligible for a CVS Health bonus, commission, or short-term incentive program in addition to the base pay range.

Benefits

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. Benefits include:

• Medical, dental, and vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs and other resources (based on eligibility).

Additional details about available benefits are provided during the application process and on Benefits Moments.