***Positions posted by El Comeback are done on behalf of companies that we support in their search for candidates.***

Our client, Abarca, is looking for a Manager, Rx Customer Service 

General Description: 

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.

As the Rx Customer Service 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 faxes) 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 team's 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 department and company policies and guidelines.
• Answers questions and recommends corrective actions to address client complaints, payment status, manual reversal requests, benefit/eligibility support, provider portal support, and response to price appeals.
• Support Account Management in client requests, meetings, or initiatives directly related to call center functions or performance.
• Manage relationships with call center-related delegated entities that are member-impacting to ensure compliance with SLAs.
• Ensure completion of letter process tasks such as a 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 you

The bold requirements

• Bachelors Degree or Masters Degree in a related area (Instead 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 other healthcare-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, and bilingual fluency in Spanish and English are required.
• We are proud to offer a flexible hybrid work model which will require certain on-site workdays (Puerto Rico Location Only)
• This position requires availability to work in a specified time zone or working schedule, accommodating the business needs of our clients and team members.
• This position may require availability for on-call hours, including evenings, weekends, and holidays, to promptly address emergent issues or provide necessary support as dictated by operational demands (if applicable).

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. 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.

***El Comeback is a non-profit program from ConPRmetidos that attracts and retains professional talent for Puerto Rico-based jobs. Register at elcomebackpr.org/registration-form to get matched with professional opportunities on the island.***