Remote/Hybrid Coverage Determination Specialist

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

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