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CVS Health Rep II Clinical Med D in Pittsburgh, Nebraska

Job Description

Our company purpose is to help people on their path to better health. As a Pharmacy Appeals Representative, you will be directly supporting Medicare Part D members and providers with 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

Required Qualifications

• 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

Preferred Qualifications

• 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

Business Overview

At CVS Health, we are joined in a common purpose: helping people on their path to better health. We are working to transform health care through innovations that make quality care more accessible, easier to use, less expensive and patient-focused. Working together and organizing around the individual, we are pioneering a new approach to total health that puts people at the heart.

We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring or promotion based on race, ethnicity, sex/gender, sexual orientation, gender identity or expression, age, disability or protected veteran status or on any other basis or characteristic prohibited by applicable federal, state, or local law. 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.