Operations Representative II

Role Overview

• 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

• 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

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