Coverage Determination Specialist (Multiple positions)

Kelly Science, Engineering, Technology & Telecom; San Juan (PR); Hybrid; USD 19,000 - 28,000; Full time

Benefits offered by this job

Hybrid work model

Weekly pay by W-2

Christmas bonus

Job summary

Kelly Science, Engineering, Technology & Telecom is hiring a Coverage Determination Specialist in Puerto Rico. The role involves creating and evaluating coverage decisions within federal regulations and client contracts, while coordinating with pharmacists, beneficiaries, and doctors to ensure accurate determinations.

The position requires on-site presence in Puerto Rico within a flexible hybrid model, strong clinical judgment, and solid communication skills to document cases and liaise with the

Qualifications

• Associate’s Degree in Pharmacy Tech or equivalent relevant work experience.
• At least 3 years of experience in customer service.
• Proficient with Microsoft Office tools (Outlook, Excel, PowerPoint, Word).
• Excellent oral and written communication skills.

Responsibilities

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

Skills

Customer service

Communication

MS Office

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
• 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

Requirements:

• Associate’s Degree in Pharmacy Technician (or equivalent, relevant work experience)
• At least 3 years of experience in customer service
• Proficient with Microsoft Office tools (Outlook, Excel, PowerPoint, and Word)
• Excellent oral and written communication skills
• 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:

• Experience in a healthcare or pharmacy setting