Verification Representative

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues — caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate.

And we do it all with heart, each and every day.

CVS Health/Specialty is offering an exciting opportunity to be part of our Benefits Verification team. This is primarily a WORK FROM HOME position. However, candidates must live within a 75-mile commutable distance from Monroeville, PA because you may also be asked to come into the office for Training, IT/ Technical issues, Performance Review/Evaluation, etc. 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.

As a Benefits Verification Representative, you are a critical liaison between our patients, healthcare professionals and insurance carriers. You will utilize your skills and healthcare industry expertise to efficiently solve insurance-related issues to process patient prescription orders for on‑time delivery. In this role, you will work in multiple systems and portals, and handle inbound patient and internal colleague calls, as well as make outbound calls on a daily basis.

Successful candidates in this role will embody our heart at work behaviors and possess:

• Excellent computer navigation skills.
• Interpersonal skills to put people first and deliver personalized patient experiences.
• Strong attention to detail.
• A solution orientated mindset removing obstacles to make experiences easier and rising to the challenge to help our patients.
• A goal‑driven work ethic.

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.

• Must live within 75 miles of Monroeville, PA.
• 1+ years of experience in a healthcare environment, with experience working with medical insurance, benefits verification, medical billing, or a related field.
• 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.

• Pharmacy or Healthcare Benefits experience.
• 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 Health Care and/or Cover My Meds .

High School Diploma or equivalent work experience.

The typical pay range for this role is: $17.00 – $28.46.

Our people fuel our future. Our teams reflect the customers,…