Operations Representative II

CVS Health

Representative II at CVS Health supporting Medicare Part D members and providers with pharmacy benefit requests. Ensuring accurate case setups and documentation in compliance with CMS guidelines.

Posted 7/9/2026full-timeRemote • Florida • 🇺🇸 United StatesJunior💰 $17 - $28 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Medicare appeals case management, ensuring compliance with CMS standards while effectively utilizing multiple software systems for accurate documentation and case processing. Strong ability to analyze information and adapt to changing work instructions in a fast-paced environment.

Highest-signal resume keywords

Medicare Appeals Case ManagementWindows Based OperationsAS400MHKManaged Care/PBM Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Case SetupDocumentation AccuracyInformation AnalysisTyping 30 WPMCase Processing

Soft Skills

Receptive to FeedbackFlexibilityAdaptability

Tools & Technologies

PeopleSafeWI DatabaseMicrosoft Office Applications

Industry Keywords

CMS ComplianceMedicare Part DProductivity StandardsQuality Standards

About the role

Key responsibilities & impact

Ensure accurate case setup and review of Medicare appeals cases
Reviewing internal notes or fax requests thoroughly for pertinent information
Providing clear, concise, and accurate documentation for case reviews
Contacting providers to obtain additional information
Utilize work instructions for accurate case processing
Complying with CMS mandated timelines and department productivity and quality standards
Acquiring and maintaining basic knowledge of relevant and changing work instructions and Medicare Part D guidance
Participate in development discussions receiving feedback from direct supervisor

Requirements

What you’ll need

Ability to utilize multiple software systems, simultaneously with a 2-screen workstation setup (Windows based operations, AS400, MHK, PeopleSafe, WI database, Microsoft office applications)
Ability to type 30 WPM or greater
Must be able to read large volumes of information and determine importance
Receptive to constructive feedback and flexible in adapting to change
Flexibility with working a rotating schedule including overtime, weekends, and holidays
Previous 6 months experience in Managed Care/PBM environment

Benefits

Comp & perks

medical, dental, and vision coverage
paid time off
retirement savings options
wellness programs
other resources, based on eligibility