Operations Representative II

This is a fully remote position, open to applicants in Florida.

📋 Description

• Ensure precise setup and review of Medicare appeals cases.

• Thoroughly examine internal notes or fax requests for relevant information.

• Deliver clear, concise, and accurate documentation for case evaluations.

• Reach out to providers to gather additional information.

• Follow work instructions to ensure accurate case processing.

• Adhere to CMS mandated timelines as well as departmental productivity and quality standards.

• Acquire and maintain fundamental knowledge of relevant and evolving work instructions and Medicare Part D guidelines.

• Engage in development discussions while receiving feedback from your direct supervisor.

⛳️ Requirements

• Proficient in utilizing multiple software systems simultaneously with a dual-screen workstation setup (Windows-based operations, AS400, MHK, PeopleSafe, WI database, Microsoft Office applications).

• Capable of typing at least 30 words per minute.

• Must be able to read extensive volumes of information and assess their significance.

• Open to constructive feedback and adaptable to changes.

• Willingness to work a rotating schedule, including overtime, weekends, and holidays.

• At least 6 months of experience in a Managed Care/PBM environment.

🏝️ Benefits

• Medical, dental, and vision coverage.

• Paid time off.

• Retirement savings options.

• Wellness programs.

• Additional resources, based on eligibility.