Prior Authorization Representative - FULL WORK FROM ...

Job DescriptionThe representative is the initial point of contact for Prior Authorization requests from members, providers, and a diverse customer base. The representative will make determinations if a complex request should be transferred to a technician or pharmacist for assistance. Additionally, they are responsible for maintaining complete, timely, and accurate documentation of all approvals and denials. To be successful in this role, you will need proficiency in pronouncing drug names and diagnoses and recognizing medical terminology. As well as navigating multiple software systems to document conversations and outcomes, which require keyboarding skills.This is a call center environment and the representative will be required to take inbound calls. This position could require mandatory overtime.We offer a comprehensive benefits package that includes medical, dental, and 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.Pay RangeThe typical pay range for this role is:Minimum: 17.02Maximum: 27.16Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.Required QualificationsRequired to provide high-speed internet.Private dedicated workspace.COVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Previous experience in pharmacy or healthcare industry 1+ years' experience in customer service or call center environments.EducationVerifiable High School Diploma, GED, or equivalent.Business OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15