Pharmacy Technician - RemoteAppleOne

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

Job Summary

We are seeking a Pharmacy Technician - Remote to support coverage determination requests for Medicare, Medicaid, and commercial health plan members. In this temp-to-hire healthcare opportunity, you will review pharmacy-related requests, communicate with pharmacies, physicians, pharmacists, and members, and help ensure timely, accurate case resolution.

This role is a strong fit for a detail-oriented pharmacy professional with excellent customer service skills, strong communication abilities, and the motivation to support patients and providers with care, accuracy, and urgency. You will be part of a collaborative pharmacy services environment with supportive leadership, structured processes, and opportunities to build valuable experience in healthcare operations, pharmacy benefits, and coverage determinations.

Key Responsibilities

- Review, document, and respond to coverage determination requests and pending pharmacy claims in an accurate and timely manner.
- Communicate with pharmacies, physicians, pharmacists, and members regarding case status, missing information, and request resolutions.
- Initiate outbound calls, faxes, and letters to gather required information and communicate coverage determination outcomes.
- Create and update cases from faxes, emails, and incoming inquiries for Medicare, Medicaid, and commercial plans.
- Support pharmacists by collecting clinical and administrative information needed for formulary, non-formulary, and exception requests.
- Follow CMS, federal, client, department, and company guidelines to ensure compliance in all coverage determination activities.

Compensation and Benefits

- Pay: $17 per hour.
- Job type: Temp-to-hire.
- Location: San Juan, PR.
- Work arrangement: Flexible hybrid work model requiring certain on-site workdays in Puerto Rico only.
- Schedule: Rotating shifts may include nights, weekends, and holidays.
- Availability may be required for a specified time zone or working schedule based on business needs.
- On-call availability may be required for evenings, weekends, and holidays, if applicable.