Job Information

Abarca Health, LLC. Supervisor, Rx Customer Service in San Juan, Puerto Rico

What you’ll doIn a few words…Abarca is igniting a revolution in healthcare.  We built our company on the belief that with smarter technology we are redefining pharmacy benefits, but this is just the beginning.Providing high quality services to client and beneficiaries is at the core of what we do every day! The PBM Operations & Services team is the very heart of Abarca and meets that standard by running services from MTM, price eligibility, configurations, and beneficiary services to government services and beyond. Rx Customer Service leads the front lines on conducting satisfaction surveys, addressing complaints, managing manual reversal requests and other needs for our beneficiaries, pharmacies and clientsAs a Supervisor Pharmacy Call Center you will lead a dedicated team through beneficiary, client, physician, and pharmacy support. You will have oversight on areas such as scheduling hours, training, reviewing service level metrics and KPIs as well as quality monitoring.  Also, you will assist the Rx Customer Service Specialists not just with escalations but also with any incoming and outgoing communications with pharmacies, beneficiaries, and prescribers. Abarca’s proprietary platforms will be open for your use; especially one of Darwin’s many modules, Rx Platform, which will aid in resolving caller’s needs.The fundamentals for the job…Prepare monthly team schedules while taking into consideration call volumes, peak hours, personnel availability, and seasonal events.Monitor Rx Customer teams’ timeliness and attendance, ensuring specialists are complying with their scheduled hours and that all information entered within payroll systems (UKG and ADP) is accurate.Monitor incoming calls and back-office duties for purposes related to quality, compliance, and employee development.Coordinate training and development courses on both a team and one-on-one basis as needed.Assist Rx Customer Service Specialists in managing all incoming calls, emails, faxes, and web-generated requests from pharmacies, beneficiaries and prescribers including but not limited to coverage determination, exception and appeal status and rejection support including overrides.Real-time, daily, and monthly monitoring of call center performance metrics to ensure proper adjustments are made in a timely manner and that all calls are managed within the service-level standards set by Center for Medicare and Medicaid Services (CMS) and our clients.Document administrative prior authorization (PA) request inquiries, issues, status, and resolution in accordance with federal and department / company policies and guidelines.Answers questions and recommends corrective actions to address customer complaints, payment status, manual reversal requests, benefit/eligibility support, provider portal support and responses to price appeals.Responsible for mentoring, development of team, performance review, growth conversation, and calibration processes.Support the Knowledge Accelerator team in creating content, as needed, for training on subject matter expertise and process.What we expect of you: The bold requirements…Associate’s Degree as Pharmacy Technician. (In lieu of a degree, equivalent relevant work experience may be considered).6+ years of experience working in pharmacy or healthcare call center areas.Experience as a Supervisor or leading teams.Experience within lines of business in pharmacy benefit management, clinical operations and/or Medicare Part D.Excellent oral and written communication skills, bilingual fluency in Spanish and English is required.We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)Nice to haves…Current and Active Certified Pharmacy Technician License.Experience in insurance, pharmacy, and / or healthcare preferred.Experience within pharmacy benefit management (PBM) clinical operations and Medicare Part D.Physical requirements…Must be able to access and navigate each department at the organization’s facilities.Sedentary work that primarily involves sitting/standing. At Abarca we value and celebrate diversity. Diversity, equity, inclusion, and belonging are guiding principles of Abarca and ensure Abarca’s workforce reflects the communities it serves.  We are proud to provide equal employment opportunities to all employees and applicants for employment and prohibit discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, medical condition, genetic information, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.Abarca Health LLC is an equal employment opportunity employer and participates in E-Verify.  “Applicant must be a United States’ citizen. Abarca Health LLC does not sponsor employment visas at this time”The above description is not intended to limit the scope of the job or to exclude other duties not mentioned. It is not a final set of specifications for the position. It’s simply meant to give readers an idea of what the role entails.