Associate Rx Customer Service Specialist

📋 Description

• Oversee all incoming communications including calls, emails, faxes, and web-based inquiries from pharmacies, beneficiaries, and prescribers.

• Adhere to the service-level standards established by CMS or the client; aim for 80% of calls to meet service level expectations, maintain a less than 5% abandonment rate, and ensure response time is under 30 seconds.

• Provide support for rejection cases, including overrides.

• Communicate Coverage Determination status to clients, including handling exceptions and appeals.

• Manage administrative prior authorizations by documenting inquiries, issues, statuses, and resolutions in compliance with federal regulations, department policies, and company guidelines.

• Address customer inquiries and suggest corrective actions for complaints related to payment status, manual reversals, benefits, eligibility support, provider portal assistance, and responses to price appeals.

• Escalate identified issues to the appropriate department for investigation and resolution, following the established procedures.

⛳️ Requirements

• Associate’s Degree in Pharmacy Technician (or an equivalent level of relevant work experience may be considered in lieu of a degree).

• A minimum of 1 year of experience in a Pharmacy or Member Services Call Center, retail, or hospital pharmacy environment.

• Outstanding oral and written communication skills in English.

• For remote work, a stable, secure, and efficient internet connection is required, along with a dedicated workspace that complies with HIPAA and PHI protocols.

• Availability to work 40 hours per week, Monday through Sunday—including holidays—with the flexibility to cover any 8-hour shift within our standard business hours of 8:00 AM to 8:00 PM PST.

🏝️ Benefits

• Abarca is committed to diversity, equity, inclusion, and belonging, ensuring that its workforce reflects the communities it serves.

• Equal employment opportunities are provided to all employees and applicants.

• Discrimination and harassment of any kind are strictly prohibited.