Associate Rx Customer Service Specialist (Temp)

Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning…

The Pharmacy Benefit Manager Operations and Services team provides high quality services to client and beneficiaries and meets that standard by running services from Medication Therapy Management (MTM), price eligibility, configurations, and beneficiary services to government services and beyond. Our Rx Customer Service team leads the front lines in conducting satisfaction surveys, addressing complaints, managing manual reversal requests and other needs for our beneficiaries, pharmacies, and clients.

As an Associate Rx Customer Service Specialist, you will serve at the front line of all incoming and outgoing communication (calls, emails, and faxes) with pharmacies, beneficiaries, and prescribers.  You will use Rx Platform and other resources as necessary to resolve caller’s needs.

The fundamentals for the job…

• Manage all incoming calls, emails, faxes and web-generated requests from pharmacies, beneficiaries, and prescribers.
• Provide service-level standards set by Centers for Medicare & Medicaid Services (CMS) or by client.
• Rejection support, including overrides.
• Provide Coverage Determination status to clients including exceptions and appeals.
• Administrative Pre-Authorizations Document, Pre-Authorizations request inquiries, issues, status, and resolution in accordance with federal and department and company policies and guidelines.
• Answer questions and recommend corrective services to address customer complaints, payment status, manual reversal requests, benefit and eligibility support, provider portal support and response to price appeals.
• Report identified issues to the appropriate department, for investigation and correction, following the established procedure.

What we expect of you

The bold requirements…

• Pharmacy Technician Associate Degree preferred. (In lieu of a degree, equivalent relevant work experience may be considered.)  
• Active Pharmacy Technician License.
• 1+ years of experience working in a Pharmacy or Member Services Call Center, Retail or Hospital Pharmacy Setting.
• Excellent oral and written communication skills, bilingual fluency in Spanish and English is required.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only).

Nice to haves…

• Experience with Pharmacy Benefit Manager clinical operations, Commercial, Employer plans and Medicare Part D.

Physical requirements…

• Must be able to access and navigate each department at the organization’s facilities.
• Sedentary work that primarily involves sitting/standing.