Pharmacy Call Center Specialist

Summary

Join Abarca's PBM Operations & Services team as an Associate Rx Customer Service Specialist! You'll be at the forefront of communication with pharmacies, beneficiaries, and prescribers, handling calls, emails, and faxes. Your responsibilities include managing incoming requests, ensuring service-level standards are met, providing coverage determination, and addressing customer complaints. You'll need experience in a pharmacy or call center setting and excellent communication skills. A Pharmacy Technician Associate Degree is preferred, but relevant experience is also considered. Abarca offers a flexible hybrid work model (Puerto Rico location only) with potential on-call hours. We value diversity and inclusion and provide equal employment opportunities.

Requirements

• Pharmacy Technician Associate Degree preferred (In lieu of a degree, equivalent relevant work experience may be considered.)
• 1+ years of experience working in a Pharmacy or Member Services Call Center, Healthcare or Hospital Pharmacy Setting
• Excellent oral and written communication skills
• Availability to work in a specified time zone, accommodating the business needs of our clients and team members based in the in the determined time zone
• This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable)
• Must be able to access and navigate each department at the organization’s facilities
• Sedentary work that primarily involves sitting/standing

Responsibilities

• Manage all incoming calls, emails, faxes and web-generated requests from pharmacies, beneficiaries, and prescribers
• Provide service-level standards set by CMS or by client; 80% of calls should fall within service level, less than 5% abandon rate and speed to answer should be less than 30 seconds
• Rejection support, including overrides
• Provide Coverage Determination status to clients including exceptions and appeals
• Administrative PAs- Document PA 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

Preferred Qualifications

• Experience in PBM, Medicare Part D, Commercial/Employer Plans, Insurance, Pharmacy, and / or healthcare
• Active Pharmacy Technician License

Benefits

Flexible hybrid work model which will require certain on-site work days (Puerto Rico Location Only)