Pharmacy Call Center Representative

About the role

The Pharmacy Call Center Representative provides telephone customer service to providers, beneficiaries, and pharmacies, handling inbound and outbound calls related to claims, reimbursements, and payments.

Key responsibilities

• Answer inbound pharmacy calls regarding claim transactions, reimbursements, payments, and related inquiries following performance metrics.
• Handle provider and beneficiary calls using call‑center scripts and ensure compliance with HIPAA and pharmacy laws.
• Document all interactions in Service Desk, OneArk, and email systems.
• Route cases to appropriate internal departments or health‑insurance carriers.
• Guide callers through claim transmission, reimbursement, and payment processes.
• Monitor the BACMAN Alert Application to manage point‑of‑sale rejections.
• Evaluate patient eligibility for coverage determinations such as DURs and HMO alerts.
• Identify system issues and forward them to the correct internal team.
• Make outbound calls when necessary and support quality‑management initiatives.
• Perform special projects or additional duties assigned by management.

Required profile

• Pharmacy Technician, Technical or Associate degree.
• Puerto Rico Board of Pharmacy Technician Registry Certificate (CPhT) or eligibility.
• 1–2 years of customer service or call‑center experience, preferably in a healthcare setting.
• Fully bilingual in Spanish and English (written and verbal).
• Strong customer‑service orientation with excellent phone, written, and listening skills.

Required skills

• Proficiency with Microsoft Windows/Office applications.
• Experience using Service Desk software.
• Familiarity with OneArk system.
• Ability to operate the BACMAN Alert Application.