Representative II

Operations Representative to support healthcare members and providers by efficiently processing coverage-related requests. In this fast-paced role, you will handle inbound and outbound calls, as well as fax-based casework, ensuring accurate and timely resolution in compliance with regulatory standards. Key Responsibilities Process incoming coverage requests, including prior authorizations and appeals, via phone and fax. Accurately set up cases, review documentation, and apply guidelines to ensure correct processing. Conduct outbound calls to members and providers to gather missing information. Maintain clear, concise, and accurate documentation of all case activity across multiple systems. Escalate complex or clinical issues to appropriate pharmacists or management when necessary. Requirements High School Diploma or GED required (Associate degree in Business, Accounting, or equivalent preferred). Minimum 6+ months of customer service, healthcare, pharmacy, or call center experience. Proficiency in navigating multiple computer systems simultaneously in a Windows-based environment. Minimum typing speed of 30 WPM and ability to perform basic mathematical calculations. professional communication and problem-solving skills. Preferred: Pharmacy Technician Certification (CPhT) or experience handling confidential patient information in a managed care environment. Schedule and Work Environment Location: 100% Remote. Must have a dedicated, secure, and quiet home workspace. Equipment Requirement: Reliable high-speed internet with the ability to hard-wire into company equipment (wireless connections and hotspots are not permitted). Hours: Flexible to work shifts between 7:00 AM – 8:00 PM CST, Monday through Friday. Availability: Must be able to work rotating weekends, holidays, and mandatory overtime during peak operational periods.

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

Responsibilities

Process incoming coverage requests, including prior authorizations and appeals, via phone and fax.
Accurately set up cases, review documentation, and apply guidelines to ensure correct processing.
Conduct outbound calls to members and providers to gather missing information.
Maintain clear, concise, and accurate documentation of all case activity across multiple systems.
Escalate complex or clinical issues to appropriate pharmacists or management when necessary

Skills

• Call center
• claims platforms
• case management systems

Qualifications

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

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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.