Representative II

Are you a customer service or healthcare professional ready for an exciting, work-from-home opportunity? We are seeking dedicated problem solvers to join our team as Coverage Determination Representatives! In this essential role, you will support Medicare members, prescribers, and providers by processing coverage-related requests via both phone and fax.

Working from the comfort of your dedicated home workspace, you will manage case setup, review prior authorization requests, perform necessary outreach, and ensure accurate documentation in accordance with strict guidelines. Our integrated, modularized training model ensures you progressively learn and practice your skills before transitioning into production work. If you bring strong communication capabilities, sharp attention to detail, and thrive in a fast-paced environment, this full-time contract role offers an outstanding platform to apply your expertise and expand your healthcare career.

salary: $20.27 - $20.28 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

Position Summary:

Support Medicare members and prescribers by processing coverage-related requests across phone and fax channels. Accurately set up cases, perform necessary outreach, and ensure compliant, timely resolution of prior authorizations, exceptions, and appeals.

Key Responsibilities:

• Process incoming prior authorizations, coverage determinations, and drug benefit exceptions via phone and fax.

• Conduct outbound calls to members and healthcare providers to gather missing clinical documentation.

• Provide clear, accurate case documentation across internal systems in compliance with mandated timelines.

• Escalate complex clinical cases or coverage questions to staff pharmacists or leadership as appropriate.

Requirements:

• High School Diploma or GED required.

• 6+ months of experience in customer service, healthcare, pharmacy, or call center operations.

• Typing speed of 30+ WPM and strong proficiency navigating multi-screen computer environments.

• Dedicated home office with a hardwired, high-speed internet connection (minimum 25 Mbps download / 5 Mbps upload).

• Availability for mandatory camera-on virtual attendance during training and team meetings.

Skills

• Basic Software Skills
• Basic Computer Skills
• Follow-up

Qualifications

• Years of experience: 2 years
• Experience level: Experienced

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.