Representative II

Position Summary We are seeking a detail-oriented and communicative Healthcare Case Intake Specialist to join our remote team. In this role, you will be on the front lines of patient care, processing coverage-related requests such as prior authorizations, coverage determinations, and appeals. You will work closely with members, prescribers, and clinical pharmacists to ensure cases are accurately documented, efficiently processed, and strictly adhere to Medicare regulations. If you have a background in healthcare, pharmacy, or customer service and thrive in a fast-paced, multi-system environment, we invite you to apply! Key Responsibilities Case Intake & Processing: Process incoming coverage-related requests from members and prescribers via phone and fax. Accurately set up cases, review documentation, and apply specific work instructions for correct and timely processing. Outreach & Communication: Conduct outbound calls to members and providers to gather missing or additional information required to complete requests. Maintain a professional, empathetic, and clear communication style at all times. Documentation & Compliance: Provide clear, concise, and accurate documentation of all case activity across internal systems. Ensure all cases are properly closed while meeting CMS-mandated timelines, quality standards, and department productivity expectations. Analysis & Problem Solving: Read, analyze, and interpret business correspondence, technical procedures, and Medicare regulations (Part D and applicable Part B processes) to support accurate decision-making. Identify and research process issues, correcting errors as needed. Escalation & Collaboration: Raise complex issues or clinical questions to Clinical Pharmacists or management. Collaborate with peers and leaders while participating in ongoing coaching and training to expand your skillset. Required Qualifications Education: Verifiable High School Diploma or GED required. Experience: Minimum of 6+ months of experience in customer service, healthcare, pharmacy, or a call center environment. Technical Skills: Proficiency in navigating multiple computer systems simultaneously in a Windows-based environment. Typing speed of 30 WPM or greater. Core Competencies: verbal and written communication skills. Ability to problem-solve, perform basic mathematical calculations, and manage multiple variables in standardized situations

salary: $20.27 - $20.28 per hour
shift: First
work hours: 7 AM - 8 PM
education: High School

Responsibilities

Case Intake & Processing: Process incoming coverage-related requests from members and prescribers via phone and fax. Accurately set up cases, review documentation, and apply specific work instructions for correct and timely processing.
Outreach & Communication: Conduct outbound calls to members and providers to gather missing or additional information required to complete requests. Maintain a professional, empathetic, and clear communication style at all times.
Documentation & Compliance: Provide clear, concise, and accurate documentation of all case activity across internal systems. Ensure all cases are properly closed while meeting CMS-mandated timelines, quality standards, and department productivity expectations.
Analysis & Problem Solving: Read, analyze, and interpret business correspondence, technical procedures, and Medicare regulations (Part D and applicable Part B processes) to support accurate decision-making. Identify and research process issues, correcting errors as needed.
Escalation & Collaboration: Raise complex issues or clinical questions to Clinical Pharmacists or management. Collaborate with peers and leaders while participating in ongoing coaching and training to expand your skillset.

Skills

• case setup
• documentation
• Medicare guidelines

Qualifications

• Years of experience: 0 years
• Experience level: Experienced

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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.