Representative II

Are you a healthcare customer service or data entry professional ready for a rewarding work-from-home opportunity? We are seeking friendly, dedicated problem solvers to join our team as remote Medicare Operations Representatives! In this vital role, you will support Medicare members, prescribers, and providers by processing critical coverage-related requests across both phone and fax channels.

Save time and money by ditching the daily commute and working from your own quiet, dedicated home office. Our comprehensive, modularized training model will set you up for long-term success as you learn to manage coverage determinations, prior authorizations, and drug benefit exceptions. If you possess strong problem-solving skills, a positive attitude, and the ability to navigate multiple computer systems with ease, this is the perfect platform to expand your healthcare administrative career.

salary: $20.27 - $20.28 per hour
shift: First
work hours: 8 AM - 4:30 PM
education: High School

Responsibilities

Position Summary:

Process Medicare Part D and Part B coverage-related requests (prior authorizations, exceptions, appeals) via inbound/outbound phone and fax channels. Ensure accurate case setup, review, documentation, and resolution in compliance with CMS guidelines and internal quality standards.

Key Responsibilities:

• Process incoming coverage requests via phone and fax from members and prescribers.

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

• Document case activity accurately across systems, ensuring CMS-mandated timelines are met.

• Interpret Medicare regulations and technical procedures to support decision-making.

• Escalate complex clinical questions to Clinical Pharmacists or management as needed.

Requirements:

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

• High School Diploma or GED required; Associate degree preferred.

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

Skills

• Industry Representative
• Telephone Etiquette
• Typing Skills
• Basic Software Skills
• Basic Computer Skills

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.