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Pharmacy Care Representative

https://www.cvshealth.com/ Logo

CVS Health

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Location:
United States , Raleigh

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Contract Type:
Not provided

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Salary:

17.00 - 25.65 USD / Hour

Job Description:

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. 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.

Job Responsibility:

  • 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

Requirements:

  • Must live within 75 miles of Raleigh, NC
  • 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
  • A secure and private home workspace free from distractions is required
  • High School Diploma or equivalent work experience

Nice to have:

  • 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
What we offer:
  • Medical, dental, vision insurance
  • Supplemental benefits and discount programs
  • Sixteen paid days off
  • Ten paid holidays
  • Affordable medical plan options
  • 401(k) plan (including matching company contributions)
  • Employee stock purchase plan
  • No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
  • Paid time off
  • Flexible work schedules
  • Family leave
  • Dependent care resources
  • Colleague assistance programs
  • Tuition assistance
  • Retiree medical access

Additional Information:

Job Posted:
February 25, 2026

Employment Type:
Fulltime
Work Type:
Remote work
Job Link Share:

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