Associate Rx Customer Service Specialist - Temp

Abarca Health • San Juan, PR

8h • Hybrid

About The Position

As the Associate Rx Customer Service Specialist, you will serve as the front line for incoming and outgoing calls, emails, and faxes with pharmacies, beneficiaries, and prescribers. You will use the Rx Platform and other resources to resolve callers’ needs. The role includes managing requests, providing rejection and coverage determination support, documenting administrative prior authorization inquiries, and addressing customer complaints and benefit-related questions. You will report identified issues to the appropriate department for investigation and correction.

The position may require working in a specified time zone or schedule to accommodate business needs. It may also require on-call availability, including evenings, weekends, and holidays, when operational demands call for it. A flexible hybrid work model with specified onsite workdays applies to the Puerto Rico location only.

Requirements

• Associate’s degree in Pharmacy Technician; equivalent relevant work experience may be considered in lieu of a degree.
• At least 1 year of experience working in a pharmacy or member services call center, retail pharmacy, or hospital pharmacy setting.
• Excellent oral and written communication skills.

Nice To Haves

• Active Pharmacy Technician License is preferred.
• Experience in PBM, Medicare Part D, commercial or employer plans, insurance, pharmacy, and/or healthcare.

Responsibilities

• Manage incoming calls, emails, faxes, and web-generated requests from pharmacies, beneficiaries, and prescribers.
• Meet service-level standards set by CMS or clients: 80% of calls within service level, an abandon rate below 5%, and speed to answer under 30 seconds.
• Provide rejection support, including overrides.
• Provide clients with Coverage Determination status, including exceptions and appeals.
• Document administrative prior authorization request inquiries, issues, status, and resolution in accordance with federal, departmental, and company policies and guidelines.
• Answer questions and recommend corrective services addressing customer complaints, payment status, manual reversal requests, benefit and eligibility support, provider portal support, and price appeals.
• Report identified issues to the appropriate department for investigation and correction according to established procedures.

What This Job Offers

• Career Level: Entry Level
• Education Level: Associate degree