Healthcare Customer Service Representative

Title: Representative II

Rate: $20.28/hr

Location: Work from Home

Schedule: Mon Fri, 8-hour shift between 7:00AM 8:00PM CST, including rotating weekend and/or holiday coverage, and potential OT during peak periods, as required

Note: This is a W2 contract position C2C, 1099, and 3rd party candidates WILL NOT be considered

As a Rep II, Operations, you will support Medicare members, prescribers, and providers by processing coverage-related requests across both phone and fax (offline) channels. This role integrates responsibilities previously segmented by channel (phone vs. fax) and line of business (Medicare Part D and applicable Medicare Part B processes), reflecting the organizations modularized training model in which colleagues progressively learn, practice, and apply end-to-end skills before fully transitioning to production work.

In this role, you will be responsible for accurate case setup, review, outreach, documentation, and timely resolution of requests in accordance with Medicare guidelines, CMS-mandated timelines, and internal quality standards. You will demonstrate strong attention to detail, professional verbal and written communication skills, and the ability to problem-solve in a highly regulated, fast-paced environment. Work will be performed through a combination of inbound and outbound phone interactions and fax-based casework.

Position Qualifications:

• A minimum of 6 months of customer service, healthcare, pharmacy, call center, or related experience
• Strong verbal and written communication skills
• Ability to problem-solve and manage multiple concrete variables in standardized situations
• Proficiency navigating multiple computer systems simultaneously in a Windows-based environment
• Ability to interpret work instructions delivered through multiple systems and formats
• Ability to perform basic mathematical calculations, including a typing speed of 30 WPM or greater
• Prior call center experience preferred
• Ability to sit for extended periods at a computer workstation
• Ability to type and use a mouse throughout the duration of the shift
• Experience in a PBM, managed care, or healthcare environment preferred
• Experience handling confidential patient or member information preferred
• Familiarity with multi-system workflows (e.g., claims platforms, case management systems, internal databases, etc.) preferred
• A minimum of a High School Diploma or GED required; Pharmacy Technician Certification (CPhT) preferred