Rep II, Operations

3 weeks ago

Please note Actual location may vary RI United States NTT DATA Full time
Rep II, Operations - Med D Prior Auth Mandatory Video Training: M-F 8:00-4:30 CST, Post Training: Schedule fall within M-F 7:00A-6:00P CST

Job Summary
  • Solid knowledge of prescription drug reimbursement, including insurance plan types, PBM and major medical benefits, prior authorizations and appeals processing.
  • Ability to work in a fast paced environment, handling both inbound and outbound calls.
  • Must be organized, detail-oriented and able to document cases clearly and accurately in accordance with the program guidelines.
  • Good communication skills are essential, both internal and external. Knowledge of Medicare benefits, enrollments and LIS assistance.
  • Plans and organizes work assignments, set priorities and completes work with a minimum of supervision.
  • Adheres to the service policy and principles of the company, as well as the program guidelines set by the department.
  • Participates in cross-training to perform all roles within the department. Communicates effectively and professionally with our program partners to assure the best possible service for our patients and partners.


In this role, you will be responsible for:
• Training and working virtually
• Utilizing multiple software systems to complete Medicare appeals case reviews
• Meeting or exceeding government mandated timelines
• Complying with turnaround time, productivity and quality standards
• Conveying resolution to beneficiary or provider via direct communication and professional correspondence
• Acquiring and maintaining basic knowledge of relevant and changing Med D guidance

Minimum Qualifications:
• At least two years of general business experience that includes problem resolution, business writing, quality improvement and customer service
• Six months of working in a virtual role where the supervisor is not physically in the same space
• Six months of PBM/pharmaceutical benefits related work
• Six months of High Volume Call Center

Preferred Qualifications:
• Working independently but be self-aware enough to know when to ask for help
• Be technically capable to understand trouble-shooting steps and be able to communicate the results to leaders or IT
• Ability to effectively communicate verbally with members and prescribers while managing multiple software systems
• Accountable and results driven
• Critical thinker/problem solver
• Receptive to constructive feedback and flexible in adapting to change
• Ability to effectively plan, prioritize, and organize time and workload
• Ability to execute successfully in a deadline-oriented, fast-paced, highly-regulated environment
• Proficient in navigation of multiple computer applications
• Proficient use of keyboard, mouse and ability to navigate 2 workstation monitors
• Ability to type more than 30 WPM

About NTT Data Services:

NTT DATA Services is a recognized leader in IT and business services, including cloud, data and applications, headquartered in Texas. As part of NTT DATA, a $30 billion trusted global innovator with a combined global reach of over 80 countries, we help clients transform through business and technology consulting, industry and digital solutions, applications development and management, managed edge-to-cloud infrastructure services, BPO, systems integration and global data centers. We are committed to our clients' long-term success. Visit nttdata.com or LinkedIn to learn more.

NTT DATA Services is an equal opportunity employer and considers all applicants without regarding to race, color, religion, citizenship, national origin, ancestry, age, sex, sexual orientation, gender identity, genetic information, physical or mental disability, veteran or marital status, or any other characteristic protected by law. We are committed to creating a diverse and inclusive environment for all employees. If you need assistance or an accommodation due to a disability, please inform your recruiter so that we may connect you with the appropriate team.

Where required by law, NTT DATA provides a reasonable range of compensation for specific roles. The starting hourly range for this remote role is 17.75. This range reflects the minimum and maximum target compensation for the position across all US locations. Actual compensation will depend on a number of factors, including the candidate's actual work location, relevant experience, technical skills, and other qualifications. This position may also be eligible for incentive compensation based on individual and/or company performance. #INDHRS

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