Military Spouse Connection Jobs

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 clients. As the Rx Customer Service Senior Manager, you will support management in the oversight of team scheduling, training, service level metrics and quality monitoring. Additionally, you will assist Rx Customer Specialists in all incoming and outgoing communications (calls, emails, and fax) with pharmacies, beneficiaries, and prescribers, as necessary. You will use RxPlatform and other resources, as necessary, to resolve the needs of the caller.The fundamentals for the job…Prepare monthly schedules 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 the information included in TRAX is correct.Monitor center calls and back-office duties for quality, compliance, and employee development purposes.Coordinate both team and one-on-one training as needed.Prepare training materials for onboarding new agents and keep updated with changes to the platform.Assist Rx Customer Service Specialists in managing all incoming calls, emails, faxes, and web-generated requests from pharmacies, beneficiaries and prescribers including 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 CMS and our Clients.Document Administrative PA request inquiries, issues, status, and resolution in accordance with federal and department and 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 response to price appeals.Member card production, provider directories and conduct client satisfaction surveysManage relationship with call center related delegated entities that are member impacting to ensure compliance with SLA’s.Support Regulatory Communications Manager in completion of letter process tasks such as daily log of batch activity, letter QA, mailing and others.Review and adjust Interactive Voice Response call trees, back-office tasks, and team processes to ensure members, pharmacies and prescribers have the best possible service experience while contacting the call center. What we expect of youThe bold requirements…Bachelor’s Degree or Master’s Degree in a related area (In lieu of a degree, equivalent relevant work experience may be considered.)8+ years working in a Pharmacy Call Center, working in a retail or hospital pharmacy setting or non-pharmacy related customer service role preferred.Experience within lines of business in pharmacy benefit management, clinical operations and/or Medicare Part D.Excellent oral and written communication skills in 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.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.