We are seeking a Pharmacy Call Center Representative for a direct-hire, full-time opportunity with a healthcare organization in San Juan, PR. This position is ideal for a detail-oriented and customer-service-oriented Pharmacy Technician who enjoys working with pharmacies and healthcare providers and supporting pharmacy benefits, claims processing, authorization requests, and drug-related inquiries. Key Responsibilities
In this role, you will serve as a key point of contact for pharmacies and providers, providing timely and professional assistance with pharmacy benefits, claims, prior authorizations, and other pharmacy-related requests. The position requires strong communication skills, attention to detail, confidentiality, and the ability to work effectively in a structured healthcare environment.
Candidates who are bilingual in Spanish and English, have pharmacy technician experience, and enjoy combining their pharmacy knowledge with customer service and administrative responsibilities will be well suited for this opportunity.
- Answer and manage telephone calls from pharmacies and healthcare providers in a timely, confidential, and courteous manner.
- Provide customer service and guidance regarding pharmacy benefits, claims, authorization requests, and other pharmacy-related inquiries.
- Document calls, drug requests, and follow-up activities accurately in electronic records.
- Review and provide orientation to pharmacies regarding applicable pharmacy benefits and procedures.
Assist pharmacies with claims processing and troubleshooting to help ensure claims are correctly and timely adjudicated.
- Perform system overrides, including prior authorization-related activities, within the PBM claims processing system as permitted by established procedures.
- Review pharmacy-related requests and use appropriate knowledge and resources to support accurate resolution.
- Maintain confidentiality and comply with applicable healthcare, CMS, and other regulatory requirements.
Follow established procedures, quality standards, and performance expectations.
Qualifications
Education
- Completion of a Pharmacy Technician course from an accredited school.
- Must possess an active, unrestricted Pharmacy Technician License in good standing to practice in Puerto Rico.
Experience
- Minimum of 2 years of experience in a retail pharmacy environment preferred.
- Experience with pharmacy claims, benefits, prior authorizations, PBM systems, or pharmacy customer service is a plus.
- Strong communication and customer service skills are required.
- Bilingual proficiency in Spanish and English is preferred/required based on business needs.
Equal Opportunity Employer / Disabled / Protected Veterans
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For temporary assignments lasting 13 weeks or longer, AppleOne is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.
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