Step into a healthcare company that’s redefining pharmacy benefits with smarter technology. As a Coverage Determination Specialist, you’ll play a vital role in ensuring patients receive accurate and timely decisions on coverage requests.
About Abarca Health
Abarca is on a mission to ignite a revolution in healthcare by making pharmacy benefits smarter, simpler, and more human. Built on cutting-edge technology and a commitment to compliance, we support providers, patients, and payers with solutions that improve outcomes and deliver value.
Schedule
- Temporary, 6-month contract
- Remote role, aligned with Pacific Time Zone schedule (availability required for evenings, weekends, and holidays)
- Hybrid option available for Puerto Rico-based employees
What You’ll Do
- Review and respond to Medicare and Commercial coverage determination requests quickly and accurately
- Communicate with physicians, pharmacists, and members to gather details and provide updates
- Document and track case status and resolutions in compliance with federal and company guidelines
- Support pharmacists with additional information needed to process exceptions
- Generate calls, letters, and faxes to notify stakeholders of determination outcomes
- Ensure all work meets CMS and Medicaid compliance requirements
What You Need
- Associate’s Degree in Pharmacy Technician (or equivalent experience)
- 3+ years of customer service experience
- Proficiency with Microsoft Office (Outlook, Excel, Word, PowerPoint)
- Strong communication skills in English, written and verbal
- Ability to work rotating shifts, including nights and weekends
- Detail-oriented with excellent problem-solving skills
Preferred
- Certified Pharmacy Technician License
- Experience in healthcare or pharmacy environments
Benefits
- Flexible hybrid model for Puerto Rico-based employees
- Inclusive, diverse work culture rooted in equity and belonging
- Competitive compensation for contract employees
Bring your skills to a team that’s pushing healthcare forward while staying grounded in empathy and compliance.
Make your next move count.
Happy Hunting,
~Two Chicks…