Associate Rx Customer Service Specialist

Abarca Health is igniting a revolution in healthcare, focusing on redefining pharmacy benefits through smarter technology. The Associate Rx Customer Service Specialist will manage communications with pharmacies, beneficiaries, and prescribers, ensuring high-quality service and addressing various customer needs.

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

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, Retail or Hospital Pharmacy Setting
• Excellent oral and written communication skills in English
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)
• This position requires 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)
• Active Pharmacy Technician License
• Bilingual fluency in Spanish in oral and written communication skills
• Experience in PBM, Medicare Part D, Commercial/Employer Plans, Insurance, Pharmacy, and / or healthcare