Pharmacy Care Representative

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

CVS Health/Specialty is offering an exciting opportunity to be part of our Pharmacy Care Representative team. In this customer service role, you will interact directly with customers to answer questions, solve problems, provide education, and maintain our company’s reputation for high-quality service. This includes new patient enrollment, verification of insurance coverage, performing benefit investigations and processing of medication orders for both new and existing patients. Qualified candidates will be comfortable in a multi-tasking, high-energy environment. Creative problem solvers with a passion for excellent customer service.

As a Pharmacy Care Rep, you will: 

• Conduct inbound or outbound phone calls to patients regarding complex Specialty medication orders, benefits verification, and new patient enrollment.

• Coordinate and process requests for new and refill order shipments. Collect appropriate information needed to ensure insurance coverage for patient medication orders

• Verify eligibility, prior authorization, and other reimbursement requirements prior to shipment.

• Assist in enrolling and tracking new customer referrals.

• Provide explanation of CVS/Specialty services to new customers

• Transfer/escalate clinical questions and issues to the staff pharmacist for resolution.

This is primarily a WORK FROM HOME position. However, candidates must live within a 75-mile commutable distance from Fairfield, NJ and be willing to come onsite for equipment/technical issues, and performance review discussions. Training allows our new team members to familiarize themselves with members of training, support, leadership, and their new peers to ensure a successful and team-focused onboarding experience.

This position is full-time and offers overtime during our business peaks. We offer a comprehensive benefits package which includes medical, dental, vision insurance as well as a wide-ranging list of supplemental benefits and discount programs.  In addition to sixteen paid days off for employees, we also offer ten paid holidays.

Our application process is 2 simple steps:

• Apply online.

• Take your time while completing our Virtual Job Tryout (VJT)

Required Qualifications

• Must live within 75 miles of Fairfield, NJ

• 1+ years of experience in a customer service role handling and resolving a high volume of complex customer needs over the phone

• 1+ years of work experience with Windows-based applications like Microsoft Office (Outlook, Excel, Teams, Word) internet navigation, and email applications.

• 1+ years of computer keyboarding experience, skills and aptitude.

• You must have a direct/hardwired internet connection to a modem/router within 7 feet of your computer and a minimum download speed of 25 mbs download and 3 mbs upload. WiFi and satellite are not permitted. A secure and private home workspace free from distractions is required.

Preferred Qualifications

• Prior healthcare work experience and familiarity with benefits, insurance, prescriptions, medical terminology

• Previous experience working with Prior Authorizations.

• Experience with various insurance plans offered by both government and commercial insurances (i.e., PPO, HMO, EPO, POS, Medicare, Medicaid, HRA’s) and coordination of healthcare benefits, including requirements for referral, authorization, and pre-determination.

• Experience with reading, and understanding medical policy information, and utilizing insurance benefit and coverage information to calculate estimated patient responsibility, taking into consideration pre-determination, referral, authorization, and contract terms.

• Experience receiving inbound calls and making outbound calls to patients to explain insurance benefits related to health insurance, and/or discussing patient financial responsibilities.

• Knowledge with using Avaya-One X, Availity, Change HealthCare and/or CoverMyMeds.

• Pharmacy Technician license

Education

• High School Diploma or equivalent work experience.

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