Representative I

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.

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.

Primary Duties and Responsibilities

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

Essential Job Functions

Regular and predictable attendance Colleague will be required to work mandatory overtime/extended work week when needed

Physical Requirements [ex. Sit, stand, stoop, bend and walk]

• Must be able to work in front of computer for duration of shift.
• Type on a keyboard or utilize a computer mouse for an extended period.    

Work Environment

Work in a climate-controlled, smoke-free internal environment; work to be performed regularly in a CVS Health location, with the option to work-from-home at the discretion of the colleague’s leader. 

Work At Home:

Dedicated home workspace needed. Must be able to provide a quiet, uninterrupted work environment. Must have a workstation that is not accessible to common traffic and is secure from unintentional access. Must have stable personal high-speed internet and ability to hard-wire into company computer (cannot use wireless internet)

Hybrid:

Work from Site Location: Colleague will work from office location and work virtual from home. Requirement for hybrid to report to office 3 days a week.

Required Qualifications

• 6 mos - 3 years required. Additional years of work experience preferred.
• Proficient computer skills and the ability to navigate in a Window’s based environment
• Ability to follow directions and adapt in a dynamic work environment
• Demonstrated sense of urgency with assignments
• Ability to read, analyze and interpret general business correspondence, technical procedures, and governmental regulations.
• Ability to identify and solve practical problems and deal with a variety of concrete variables in standardized situations. Ability to perform basic mathematic calculations maybe required.
• Ability to interpret a variety of work instructions provided through a variety of mediums.

Preferred Qualifications

• Excellent verbal and written communication and interpersonal skills with ability to maintain patient confidentiality
• Demonstrated problem-solving ability and attention to detail
• Strong organizational skills

Education

H.S or Equivalent required. Associate’s Degree or Bachelor’s Degree, preferred.

Anticipated Weekly Hours

40

Time Type

Full time

Pay Range

The typical pay range for this role is:

$17.00 - $28.46

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

We anticipate the application window for this opening will close on: 08/06/2026

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.