Medicare Operations Representative II

Job Summary

Supporting Medicare members and healthcare providers, the full-time salaried Medicare Operations Representative II will process coverage-related requests through phone and fax, ensuring compliance with Medicare guidelines in an onsite environment.

Key Responsibilities

• Process prior authorizations, coverage determinations, and appeals received via phone or fax
• Conduct inbound and outbound calls to gather necessary information and document case activities across multiple systems
• Ensure timely completion of cases in accordance with CMS timelines and departmental quality standards

Required Qualifications

• At least six months of customer service, healthcare, pharmacy, or call-center experience
• Verifiable high school diploma or GED
• Typing speed of at least 30 WPM
• Ability to navigate multiple Windows-based computer systems simultaneously
• Strong data-entry skills and attention to detail