Pharmacy Call Center Specialist

Summary

Join Abarca, a healthcare revolutionizing company, and become an Associate Rx Customer Service Specialist! You will be at the forefront of communication with pharmacies, beneficiaries, and prescribers, resolving their needs using our Rx Platform and other resources. This role demands excellent communication skills and bilingual fluency in Spanish and English. You will manage incoming calls, emails, and faxes, ensuring service-level standards are met. Prior pharmacy or member services call center experience is required, along with an Associate's Degree in Pharmacy Technician or equivalent experience. Abarca offers a flexible hybrid work model (Puerto Rico location only) with potential on-call hours.

Requirements

• Associate’s Degree in Pharmacy Technician (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, Retail or Hospital Pharmacy Setting
• Excellent oral and written communication skills
• Bilingual fluency in Spanish and English is required
• 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
• 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

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

Benefits

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