Job Summary

We are seeking a Pharmacy Technician - Remote to support coverage determination requests for Medicare, Medicaid, and commercial health plan members. In this temp-to-hire healthcare opportunity, you will review pharmacy-related requests, communicate with pharmacies, physicians, pharmacists, and members, and help ensure timely, accurate case resolution.

This role is a strong fit for a detail-oriented pharmacy professional with excellent customer service skills, strong communication abilities, and the motivation to support patients and providers with care, accuracy, and urgency. You will be part of a collaborative pharmacy services environment with supportive leadership, structured processes, and opportunities to build valuable experience in healthcare operations, pharmacy benefits, and coverage determinations.

Key Responsibilities

- Review, document, and respond to coverage determination requests and pending pharmacy claims in an accurate and timely manner.
- Communicate with pharmacies, physicians, pharmacists, and members regarding case status, missing information, and request resolutions.
- Initiate outbound calls, faxes, and letters to gather required information and communicate coverage determination outcomes.
- Create and update cases from faxes, emails, and incoming inquiries for Medicare, Medicaid, and commercial plans.
- Support pharmacists by collecting clinical and administrative information needed for formulary, non-formulary, and exception requests.
- Follow CMS, federal, client, department, and company guidelines to ensure compliance in all coverage determination activities.

Compensation and Benefits

- Pay: $17 per hour.
- Job type: Temp-to-hire.
- Location: San Juan, PR.
- Work arrangement: Flexible hybrid work model requiring certain on-site workdays in Puerto Rico only.
- Schedule: Rotating shifts may include nights, weekends, and holidays.
- Availability may be required for a specified time zone or working schedule based on business needs.
- On-call availability may be required for evenings, weekends, and holidays, if applicable.

Required Qualifications and Skills

- Review and process coverage determination requests for Medicare, Medicaid, and commercial plan beneficiaries.
- Communicate with pharmacies, physicians, members, and pharmacists to resolve pending cases.
- Document case inquiries, issues, statuses, and resolutions in accordance with compliance requirements.
- Support pharmacy benefit operations by gathering information needed for clinical review and exception decisions.

- Associate’s Degree in Pharmacy Technician, or equivalent relevant work experience in lieu of a degree.
- 3+ years of customer service experience.
- Proficiency with Microsoft Office tools, including Outlook, Excel, PowerPoint, and Word.
- Strong oral and written communication skills.
- Ability to work rotating shifts, including nights, weekends, and holidays.
- Ability to manage sensitive healthcare information with accuracy, professionalism, and confidentiality.
- Strong attention to detail, follow-through, and ability to work in a fast-paced healthcare services environment.
- Commitment to compliance with CMS, federal regulations, client contracts, and internal policies.

Preferred Qualifications

- Experience in pharmacy benefits, prior authorization, coverage determinations, claims adjudication, or managed care.
- Familiarity with Medicare, Medicaid, or commercial health plan processes.
- Bilingual communication skills may be helpful in a Puerto Rico-based healthcare support environment.

Equal Opportunity Employer / Disabled / Protected Veterans

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The pay transparency policy is available here:
https://www.dol.gov/sites/dolgov/files/ofccp/pdf/pay-transp_%20English_formattedESQA508c.pdf

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.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

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https://e-verify.uscis.gov/web/media/resourcesContents/E-Verify_Participation_Poster_ES.pdf

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.