Coverage Determination Specialist - Temp

Abarca Health(1 day ago)

HybridFull TimeMedior$81,925 - $110,057 (estimated)PBM Operations & Services

About this role

A Coverage Determination Specialist at Abarca works within the PBM Operations & Services organization to support coverage decision processes for Medicare, Medicaid and commercial plan beneficiaries. The role focuses on applying clinical knowledge while interacting with pharmacists, physicians and members and ensuring compliance with federal regulations and client contracts. It supports the company’s mission to improve pharmacy benefits through technology-driven services.

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Required Skills

Coverage Determination
Customer Service
Communication
Microsoft Office
Case Documentation
Compliance
Pharmacy Knowledge
Bilingual (English Spanish)
Call Handling
Triage

Qualifications

Associate Degree in Pharmacy Technician
Certified Pharmacy Technician (preferred)
US Citizenship

About Abarca Health

abarcahealth.com

Abarca Health is a technology-driven pharmacy benefit manager (PBM) that delivers innovative PBM solutions to health plans, employers, and public programs. The company combines advanced analytics, clinical programs, and modern technology to manage drug spend, optimize formularies, and improve patient outcomes. Abarca emphasizes transparency, flexible contracting models, and member-centric services, including specialty drug management and patient support. Its offerings are positioned to reduce costs while streamlining pharmacy benefit operations for payers and providers.