Coverage Determination Specialist (Multiple)

Kelly; San Juan (PR); Hybrid; USD 19,000 - 28,000; Full time

Benefits offered by this job

Weekly pay by W-2

Paid vacations, sick & holidays

Christmas bonus

Hybrid work model (PR) with on-site

Job summary

Kelly Science & Clinical is seeking multiple Coverage Determination Specialists in Puerto Rico. The role involves creating and evaluating coverage determinations, communicating with clinicians and beneficiaries, and applying clinical knowledge to ensure accurate decisions.

A hybrid work model with on-site days is offered, with weekly W-2 pay and comprehensive benefits. Requirements include an Associate’s Degree in Pharmacy Technician or equivalent experience, 3+ years in customer service, and

Qualifications

• Associate’s Degree in Pharmacy Technician or equivalent healthcare experience.
• 3+ years of experience in customer service.
• Proficient with Microsoft Office tools (Outlook, Excel, PowerPoint, Word).
• Excellent oral and written communication skills.
• Willing to work rotating shifts, including nights, weekends and holidays; on-site in Puerto Rico as part of a hybrid model.

Responsibilities

• Create and evaluate coverage determinations for clients in compliance with federal regulations and contracts.
• Communicate with pharmacists, beneficiaries, and doctors regarding pending determinations.
• Apply clinical knowledge to provide thorough and accurate evaluations.
• Maintain meticulous documentation and follow up on cases as required.
• Report to Coverage Determination Supervisor or designated manager.

Skills

Customer service

Communication

Clinical knowledge

Rotating shifts

On-call availability

Education

Associate's Degree in Pharmacy Technician

Tools

Outlook

Excel

PowerPoint

Word

Job description

Ready to join a company that’s on the move? That’s where Kelly® Science & Clinical comes in.

We’re seeking multiple Coverage Determination Specialist to work in leading healthcare technology and pharmacy benefits organization in Puerto Rico. This is your opportunity to join an innovative organization, work remotely, and help improve healthcare outcomes for members every day.

Salary: $17 per hour

Location: Puerto Rico (needs to be onshore)

Why You Should Apply To Be Coverage Determination Specialist

• Competitive pay rate
• Opportunity to work with a respected leader in the healthcare industry
• Flexible hybrid work model (Puerto Rico location only) with required on-site days
• Join a supportive team environment that values your clinical expertise and commitment
• Build your career within a dynamic and growing field
• Weekly pay by W-2
• Vacations, Sick & Holidays paid*
• Christmas bonus*
• Must comply with minimum established requirements to qualify.

What’s a typical day as Coverage Determination Specialist? You’ll be:

• Creating and evaluating coverage determinations for clients, ensuring compliance with federal regulations and client contracts
• Communicating with pharmacists, beneficiaries, and doctors regarding pending coverage determinations
• Applying clinical knowledge to each coverage determination case to provide thorough and accurate evaluations
• Maintaining meticulous documentation and following up on cases as required
• Reporting to the Coverage Determination Supervisor or designated manager

This job might be an outstanding fit if you:

• Have an Associate’s Degree in Pharmacy Technician (or equivalent, relevant work experience)
• Bring 3+ years of experience in customer service
• Are proficient with Microsoft Office tools (Outlook, Excel, PowerPoint, and Word)
• Possess excellent oral and written communication skills
• Are available to work rotating shifts, including nights, weekends, and holidays, and for on-call hours as operationally required
• Are willing and able to work on-site as part of a flexible hybrid model in Puerto Rico
• Preferred but not required:
  • Certified Pharmacy Technician License
  • Experience in a healthcare or pharmacy setting

As part of our promise to talent, Kelly supports those who work with us through a variety of benefits, perks, and work-related resources. Please note: The following benefits reflect Kelly's general offerings. Eligibility may vary by assignment, location, and job type. Kelly offers eligible employees voluntary benefit plans including medical, dental, vision, telemedicine, term life, whole life, accident insurance, critical illness, a legal plan, and short-term disability. As a Kelly employee, you will have access to a retirement savings plan, service bonus and holiday pay plans (earn up to eight paid holidays per benefit year), and a transit spending account. In addition, employees are entitled to earn paid sick leave under the applicable state or local plan.

Why Kelly® Science & Clinical?

Kelly Science & Clinical is your connection to premier scientific and clinical companies looking to hire industry experts just like you. Our team creates expert talent solutions to solve the world’s most critical challenges. Every day, we match science professionals with dream jobs that fit their skills, interests, and career goals it’s the way we think job searching should be. Nearly 100 percent of our science recruiters have a professional background and education in science, so we know a thing or two about the science market and how to get your expertise noticed.

About Kelly

Work changes everything. And at Kelly, we’re obsessed with where it can take you. To us, it’s about more than simply accepting your next job opportunity. It’s the fuel that powers every next step of your life. It’s the ripple effect that changes and improves everything for your family, your community, and the world. Which is why, here at Kelly, we are dedicated to providing you with limitless opportunities to enrich your life-just ask the 300,000 people we employ each year.

Kelly is committed to providing equal employment opportunities to all qualified employees and applicants regardless of race, color, sex, sexual orientation, gender identity, religion, national origin, disability, veteran status, age, marital status, pregnancy, genetic information, or any other legally protected status, and we take affirmative action to recruit, employ, and advance qualified individuals with disabilities and protected veterans in the workforce. Requests for accommodation related to our application process can be directed to the Kelly Human Resource Knowledge Center. Kelly complies with the requirements of California’s state and local Fair Chance laws. A conviction does not automatically bar individuals from employment. Kelly participates in E-Verify and will provide the federal government with your Form I-9 information to confirm that you are authorized to work in the U.S.

Kelly may use AI-powered tools during the recruitment and hiring process. For full details, including how Kelly uses AI, your rights, and how to request a reasonable accommodation, visit the Recruitment Artificial Intelligence Notice.