Step into a healthcare company that’s redefining pharmacy benefits with smarter technology. As a Coverage Determination Specialist, you’ll play a vital role in ensuring patients receive accurate and timely decisions on coverage requests.

About Abarca Health
Abarca is on a mission to ignite a revolution in healthcare by making pharmacy benefits smarter, simpler, and more human. Built on cutting-edge technology and a commitment to compliance, we support providers, patients, and payers with solutions that improve outcomes and deliver value.

Schedule

  • Temporary, 6-month contract
  • Remote role, aligned with Pacific Time Zone schedule (availability required for evenings, weekends, and holidays)
  • Hybrid option available for Puerto Rico-based employees

What You’ll Do

  • Review and respond to Medicare and Commercial coverage determination requests quickly and accurately
  • Communicate with physicians, pharmacists, and members to gather details and provide updates
  • Document and track case status and resolutions in compliance with federal and company guidelines
  • Support pharmacists with additional information needed to process exceptions
  • Generate calls, letters, and faxes to notify stakeholders of determination outcomes
  • Ensure all work meets CMS and Medicaid compliance requirements

What You Need

  • Associate’s Degree in Pharmacy Technician (or equivalent experience)
  • 3+ years of customer service experience
  • Proficiency with Microsoft Office (Outlook, Excel, Word, PowerPoint)
  • Strong communication skills in English, written and verbal
  • Ability to work rotating shifts, including nights and weekends
  • Detail-oriented with excellent problem-solving skills

Preferred

  • Certified Pharmacy Technician License
  • Experience in healthcare or pharmacy environments

Benefits

  • Flexible hybrid model for Puerto Rico-based employees
  • Inclusive, diverse work culture rooted in equity and belonging
  • Competitive compensation for contract employees

Bring your skills to a team that’s pushing healthcare forward while staying grounded in empathy and compliance.

Make your next move count.

Happy Hunting,
~Two Chicks…

APPLY HERE