TEMP BPO Associate

NTT DATA Services•Lincoln, RI

5d•Onsite

About The Position

As a Rep II, Operations, you will support Medicare members, prescribers, and providers by processing coverage-related requests across both phone and fax (offline) channels. This role integrates responsibilities previously segmented by channel (phone vs. fax) and line of business (Medicare Part D and applicable Medicare Part B processes), reflecting the organization’s modularized training model in which colleagues progressively learn, practice, and apply end‐to‐end skills before fully transitioning to production work. In this role, you will be responsible for accurate case setup, review, outreach, documentation, and timely resolution of requests in accordance with Medicare guidelines, CMS-mandated timelines, and internal quality standards. You will demonstrate strong attention to detail, professional verbal and written communication skills, and the ability to problem-solve in a highly regulated, fast-paced environment. Work will be performed through a combination of inbound and outbound phone interactions and fax-based casework. Colleagues are trained across both phone and fax-based workflows and progressively apply learned skills through practice before full production deployment.

Requirements

1+ years working in a healthcare or pharmacy customer service focused role
1+ years customer service, Call center experience a plus
2+ years MS office in an office environment
High school diploma or GED required

Responsibilities

Process incoming coverage-related requests (e.g., prior authorizations, coverage determinations, drug benefit exceptions, appeals) via phone and fax from members and prescribers.
Accurately set up cases, review documentation, and apply work instructions to ensure correct and timely processing.
Read, analyze, and interpret business correspondence, technical procedures, and Medicare regulations to support decision-making.
Conduct outbound calls to members and providers to obtain missing or additional information required to complete requests.
Communicate clearly, professionally, and empathetically while projecting a positive business image.
Provide clear, concise, and accurate documentation of all case activity across systems.
Ensure all cases are properly closed and meet CMS-mandated timelines, department productivity expectations, and quality standards.
Identify and research issues in the overall process and correct errors when identified.
Raise complex issues or clinical questions to Coverage/Organization Determination Clinical Pharmacists or management as appropriate.
Collaborate with peers, trainers, and leaders while progressing through modular training and skill expansion.
Acquire and maintain working knowledge of evolving work instructions, systems, and Medicare guidance (Part D and applicable Part B processes).
Participate in coaching, feedback, and development discussions with direct leadership.