Representative I

Tittle: Representative
Location: Woonsocket RI 02895
Duration : 11/16/2026 to 10/17/2027
Pay Range: $18.00 - $18.98

Safety Sensitive


On the top of each resume:
**include City, State & Time Zone on top of resume**
*Must provide internet speed test on the resume (INCLUDE SCREEN SHOT) - www.speedtest.net
***Certification/License NOT Required**

Shift: Training Hours are 9a-5:30p EST. Working hours will be a rotating shift between the hours of 8a-8p EST

In this role, Coverage Determination Representative I, contractors will be responsible for:
Utilizing multiple software systems to create Medicare Prior Authorization case reviews
Meeting or exceeding government mandated timelines
Complying with turnaround time, productivity, and quality standards
Acquiring and maintaining basic knowledge of relevant and changing Med D guidance

Please review with candidate, complete, and copy on top of resume:
1. Attendance is extremely important, especially during the initial 8 weeks of training. The new hire must be available M-F from 9am-5:30pm EST for the first 8 weeks (no vacation time planned). All time off needed should be discussed and disclosed during this initial review.
Do you have any conflicts with the training schedule or time off planned during assignment duration?

2. After training, our hours of operation are 8-8 EST M-F with rotating weekend schedules. they must be available for the rotating weekend. Do you have any conflicts working an assigned 8-hour shift between 8AM 8PM EST and rotating weekends?

3. This is a Remote position. Must have a dedicated quiet, separate space in which to work with wired internet meeting 25mbps min download and 5mbps minimum upload speed. Previous WFH experience is preferred.
Do you have a separate workspace with no interruptions?
*Please include internet speed in screenshot at top of resume*

4. Must be able to sit and focus on work for the duration of shift.
Are you able to sit and focus with no interruptions for entire shift?

5. Data entry and navigating multiple computer applications while utilizing two screens is the primary function of job (possible outbound calls needed). A job history demonstrating this is recommended.
Do you have data entry experience?

6. Pharmacy or medical background is preferred.
Do you have a Pharmacy or Medical background?

7. Successfully worked independently in a data entry, productivity driven role is preferred
Are you able to work independently?

8. As a company we strive for a team that is engaged and positive so candidates that demonstrate this would be ideal
Do you feel you have the engagement and positive attitude to work this assignment?

Opportunity for full-time employment contingent on performance
Virtual interviews with supervisors via Teams or phone.
Hours of operation 8-8 EST M-F with rotating weekend schedules

Position Summary:

The Coverage Determination/Appeals Service Representative I is responsible for working and triaging in the data entry related fax queues. The Representative I s primary responsibilities will be to review each document with accuracy and place the case in the proper queues.

Further responsibilities include researching reports, maintaining complete, timely and accurate documentation of Coverage Determination/Appeal requests and escalating issues to the Coverage Determination/Appeal pharmacists or management staff as needed.

Position will require schedule flexibility including rotations through Nights, Weekends and Holiday Coverage. All other duties are required to meet business needs.

Training hours Mon- Fri 9-5:30pm EST
Working hours with rotating weekends Mon-Fri 8-8pm EST

Duties:

Responsibilities
1. Review Fax documents appropriately and forward to appropriate queues
2.Update and maintain knowledge of relevant process, regulation and clinical material.
3.Provide assistance or guidance in partnership with learning and innovation when needed
4.Participate in developmental discussions receiving feedback with Supervisor

Experience:

Previous medical insurance background preferred but not required.

Education:

High School diploma or GED