Abarca Health

Coverage Determination Specialist

Abarca Health(29 days ago)

HybridFull TimeMedior$101,208 - $134,812 (estimated)Pharmacy Operations
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About this role

A Coverage Determination Specialist at Abarca evaluates and supports coverage decision processes for pharmacy benefits on behalf of clients, ensuring cases meet federal and client standards. The role is based in Puerto Rico with a flexible hybrid schedule, requires bilingual fluency, and supports compliance with regulatory requirements.

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Required Skills

  • Coverage Determination
  • Customer Service
  • Microsoft Office
  • Spanish Fluency
  • Case Documentation
  • Phone Support
  • Physician Outreach
  • Pharmacy Support
  • CMS Compliance
  • Fax Management

Qualifications

  • Associate's Degree in Pharmacy Technician
  • Certified Pharmacy Technician License
Abarca Health

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.

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