Associate Rx Customer Service Specialist

About the role

Abarca is redefining pharmacy benefits through smarter technology. The PBM Operations & Services team is the heart of Abarca, delivering services such as MTM, price eligibility, configurations, beneficiary services, and government programs. As an Associate Rx Customer Service Specialist, you will serve as the front line for all incoming and outgoing communication (calls, emails, and faxes) with pharmacies, beneficiaries, and prescribers, resolving their needs using the Rx Platform and other resources.

Responsibilities

• Manage all 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, less than 5% abandon rate, and speed to answer under 30 seconds.
• Provide rejection support, including overrides.
• Communicate Coverage Determination status to clients, including exceptions and appeals.
• Document Prior Authorization (PAS) requests, issues, status, and resolution in accordance with federal, department, and company policies.
• Answer questions and recommend corrective services for 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, following established procedures.

Requirements

• Pharmacy Technician Associate Degree preferred (equivalent relevant work experience may be considered in lieu of a degree).
• 1+ years of experience in a Pharmacy or Member Services Call Center, Retail, or Hospital Pharmacy Setting.
• Excellent oral and written communication skills in English.
• Availability to work in a specified time zone to accommodate client and team needs.
• This position may require on-call hours, including evenings, weekends, and holidays, to address emergent issues or provide support as needed.

Preferred Qualifications

• Active Pharmacy Technician License.
• Bilingual fluency in Spanish (oral and written).
• Experience in PBM, Medicare Part D, Commercial/Employer Plans, Insurance, Pharmacy, and/or healthcare.

Physical Requirements

• Ability to access and navigate each department at the organization's facilities.
• Sedentary work primarily involving sitting/standing.

Schedule

This role follows a flexible hybrid work model with required on-site workdays (Puerto Rico location only).