Remote Pharmacy Call CenterAppleOne

AppleOne, a division of the Act-1 Group, is proud to present:

Job Summary

We are seeking a Pharmacy Call Center Representative for a temporary remote opportunity. In this role, you will be the first point of contact for pharmacies, beneficiaries, and prescribers, helping resolve pharmacy benefit, coverage, eligibility, prior authorization, and service-related inquiries.

This is a strong opportunity for a pharmacy technician or healthcare call center professional who enjoys problem-solving, supporting patients and providers, and working in a collaborative healthcare services environment. The role offers exposure to pharmacy benefits, Medicare Part D, claims support, coverage determinations, and customer care operations within a team-focused setting that values service quality, inclusion, and professional growth.

Key Responsibilities

- Manage incoming and outgoing calls, emails, faxes, and web-generated requests from pharmacies, beneficiaries, and prescribers.
- Provide support for pharmacy claim rejections, overrides, payment status, manual reversal requests, benefit questions, eligibility issues, and provider portal inquiries.
- Share coverage determination status updates, including exceptions, appeals, and related case information.
- Document prior authorization inquiries, issues, statuses, and resolutions according to federal, department, and company guidelines.
- Meet service-level expectations, including call response time, abandonment rate, and overall customer service standards.
- Report identified issues to the appropriate department for investigation, resolution, and process improvement.

Compensation and Benefits

- Pay rate: $17.00 per hour.
- Job type: Contract/Temporary.
- Location: San Juan, PR.
- Work arrangement: Remote.
- Schedule: Must have open availability for rotating shifts.
- May require on-call availability, including evenings, weekends, and holidays, if operational needs require support.