representative ii.pawtucket, rhode island (remote)posted august 10, 2026 job detailssummary$20.27 - $20.28 per hourtemporaryhigh schoolcategoryoffice and administrative support occupations reference AB_5008421 job details About the Role We are seeking a remote Operations Representative II to support Medicare members and providers by processing coverage-related requests (e.g., prior authorizations, appeals) via phone and fax. In this fast-paced role, you will accurately set up cases, review medical documentation, and ensure all requests are resolved in strict compliance with CMS guidelines. Key Responsibilities Intake, process, and accurately document coverage requests across multiple systems. Conduct outbound calls to members and healthcare providers to gather missing information. Ensure all casework meets CMS-mandated timelines, quality standards, and productivity metrics. Escalate complex clinical questions to pharmacists or management as needed. Requirements High School Diploma or GED required (Pharmacy/Medical background preferred). 6+ months of experience in customer service, healthcare, call center, or data entry. Typing speed of 30+ WPM with the ability to navigate multiple systems simultaneously on dual monitors. verbal and written communication skills with a highly detail-oriented mindset.

Schedule & Technical Requirements Training:

First 8 weeks are Mon-Fri, 8:00 AM - 4:30 PM CST. (No time off permitted during this period).

Standard Shifts:

Assigned 8-hour shifts between 7:00 AM - 8:00 PM CST (Mon-Fri), including mandatory rotating weekends and holidays. Overtime may be required.

Workspace:

A dedicated, quiet, distraction-free home office environment.

Internet:

Hard-wired internet connection only (no Wi-Fi or hotspots) with minimum speeds of 25 Mbps download / 5 Mbps upload.

Camera:

Must be willing to be on camera for training and team meetings.

salary:

$20.27 - $20.28 per hourshift: Firstwork hours: 7 AM - 8

PMeducation:

High SchoolResponsibilitiesIntake, process, and accurately document coverage requests across multiple systems. Conduct outbound calls to members and healthcare providers to gather missing information. Ensure all casework meets CMS-mandated timelines, quality standards, and productivity metrics. Escalate complex clinical questions to pharmacists or management as needed. Skillsaccurate case setupdocumentationMedicare guidelinesQualificationsYears of experience: 0 yearsExperience level: ExperiencedRandstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer:

Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact HRsupport@randstadusa.com.

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).This posting is open for thirty (30) days. It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.