Remote Coverage Determination Specialist in Healthcare

Kelly

San Juan (PR)

Hybrid

USD 19,000 - 28,000

Full time

4 days ago

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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.