Call Center - Clinical Representative

Position Summary:
As a Clinical Representative, you will work closely with healthcare providers to process Prior Authorizations (PA) and drug benefit exception requests in a call center environment. In the Clinical Representative role, you will play a meaningful role in ensuring member and client satisfaction. You will be performing all work in accordance with Medicare Part D guidelines. In this role, you would have flexibility to work any shift between 7:00am - 10:00pm (Monday - Friday) and 7:00 am - 5:00 pm(Saturday - Sunday).

As a Clinical Representative, you'll sho w a high level of attention to detail, verbal and written communications skills, and the ability to problem solve in this dynamic work environment. You’ll be working various assignments that require demonstrated urgency and the ability to meet set timelines. You’ll have the opportunity to project a professional business image through phone interactions as well as internal communication.

Your responsibilities will include:
- Working incoming cases via phone or fax to process coverage requests from members or prescribers
- Conducting outreach to patients and providers, and obtaining additional information needed to process requests
- Researching and correcting any issues found in the overall process
- Raising issues to Coverage Determination Clinical Pharmacists and Management team as needed
- Reading, analyzing, and interpreting general business correspondence,technical procedures, and governmental regulations
- Solving practical problems and dealing with multiple concrete variables in standardized situations
- Performing basic mathematical calculations
- Ensuring all cases are properly closed
- Ability to interpret a variety of work instructions provided through multiple mediums
- Ability to anticipate needs and resolve issues with urgency and to meet quality and production standards
- Schedule flexibility including rotations through Nights, Weekend and Holiday Coverage

Required Qualifications:
6+ months of customer service or related experience
6+ months of navigating a Windows based environment including ability to toggle between multiple programs, ability to navigate web based systems as well as DOS based systems, and adaptable to system changes and upgrades

Preferred Qualifications:
Call center experience Pharmacy or PBM environment
Experience in a role requiring maintenance of patient confidentiality


Business Overview:
CVS Health, through our unmatched breadth of service offerings, is transforming the delivery of health care services in the U.S. We are an innovative, fast-growing company guided by values that focus on teamwork, integrity and respect for our colleagues and customers. What are we looking for in our colleagues? We seek fresh ideas, new perspectives, a diversity of experiences, and a dedication to service that will help us better meet the needs of the many people and businesses that rely on us each day. As the nation’s largest pharmacy health care provider, we offer a wide range of exciting and fulfilling career opportunities across our three business units – MinuteClinic, pharmacy benefit management (PBM) and retail pharmacy. Our energetic and service-oriented colleagues work hard every day to make a positive difference in the lives of our customers.

CVS Health is an equal opportunity employer. We do not discriminate in hiring or employment against any individual on the basis of race, ethnicity, ancestry, color, religion, sex/gender (including pregnancy), national origin, sexual orientation, gender identity or expression, physical or mental disability, medical condition, age, veteran status, military status, marital status, genetic information, citizenship status, unemployment status, political affiliation, or on any other basis or characteristic prohibited by applicable federal, state or local law. CVS Health will consider qualified job candidates with criminal histories in a manner consistent with federal, state and local laws. CVS Health will not discharge or in any other manner discriminate against any Colleague or applicant for employment because such Colleague or applicant has inquired about, discussed, or disclosed the compensation of the Colleague or applicant or another Colleague or applicant. Furthermore, we comply with the laws and regulations set forth in the following EEO is the Law Poster: EEO IS THE LAW and EEO IS THE LAW SUPPLEMENT

Federal law requires employers to provide reasonable accommodation to qualified individuals with disabilities. If you require assistance to apply for this job, please contact us by clicking EEO AA CVS Health

CVS Health does not require nor expect that applicants disclose their compensation history during the application, interview, and hiring process.

For inquiries related to the application process or technical issues please contact the Kenexa Helpdesk at 1-855-338-5609. For technical issues with the Virtual Job Tryout assessment, contact the Shaker Help Desk at 1-877-987-5352. Please note that we only accept resumes via our corporate website:

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